Clinical studyAn invasive strategy is associated with decreased mortality in patients with unstable angina and non–ST-elevation myocardial infarction: GUSTO IIb trial
Section snippets
Study group
Prospective data were collected from patients enrolled in the GUSTO IIb trial (10). Briefly, the inclusion criteria consisted of chest pain within the previous 12 hours that was associated either with transient or persistent ST-segment elevation or depression of more than 0.5 mm, or with persistent, definite T-wave inversion of more than 1 mm. A total of 12,142 patients were enrolled in the trial. For our analysis, we included the 8011 patients who did not have ST-segment elevation. Of those,
Results
After eliminating patients with missing catheterization information and patients who died before the median time to catheterization, there were 7897 patients in our analysis. Of those, 4536 patients (57%) underwent in-hospital catheterization, including 2591 (57%) who underwent revascularization: 1585 (63%) with percutaneous coronary intervention and 1006 (40%) with coronary artery bypass grafting. The remainder of the patients (n = 3361 [43%]) did not undergo catheterization prior to
Discussion
The optimal utilization of cardiac catheterization and coronary revascularization for patients with unstable angina and non–ST-elevation myocardial infarction remains controversial. Whereas the TIMI IIIB and VANQWISH trials did not show a benefit with an early invasive strategy, the FRISC II and TACTICS-TIMI 18 trials did report that invasive therapy led to better outcomes 5, 6, 7, 8, 9. Our data from a large cohort of patients with acute coronary syndromes suggest that an invasive strategy is
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Cited by (16)
Mean length of stay and prognosis in unstable angina. Results from the ARIAM database
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2006, Journal of Clinical EpidemiologyCitation Excerpt :We excluded 48 articles that did not include analysis of data (28), randomized clinical trials (9), case-control studies (2), and articles primarily analyzing cost-effectiveness (6) or practice patterns (3). Our search revealed 58 substantive medical research studies that used PS in 2003 [18–75], 38 in 2002 [76–113], 28 in 2001 [114–141], 6 in 2000 [142–147], 5 in 1999 [148–152], 5 in 1998 [153–157], and a total of 5 before 1998 [158–162]. Additional articles found through a citation search of the significant methods articles written about PS, using Science Citation Index, yielded 13 medical research studies that used PS in 2003 [163–175], 13 in 2002 [176–188], 11 in 2001 [189–199], 3 in 2000 [200–202], 1 in 1999 [203], 3 in 1998 [204–206], and a total of 3 before 1998 [207–209].
Relation of timing of cardiac catheterization to outcomes in patients with non-ST-segment elevation myocardial infarction or unstable angina pectoris enrolled in the multinational Global Registry of Acute Coronary Events
2005, American Journal of CardiologyCitation Excerpt :The present analysis used data from patients who had been hospitalized with a diagnosis of unstable angina pectoris or NSTEMI, had undergone early invasive management with standard catheterization procedures, and were enrolled in the Global Registry of Acute Coronary Events. Previously reported trials have addressed the use of invasive management strategies in patients who have unstable angina pectoris or NSTEMI,1–5,15–19 and some have shown benefits over conservative strategies for long-term outcomes.1–5,17–19 However, there have been few reports that have specifically investigated the effect of timing of catheterization in this category of patients who have ACS.6,8
Outcome analysis of one year after an invasive compared with noninvasive strategy in unstable angina
2019, Pakistan Journal of Medical and Health SciencesEarly Invasive Strategy for Unstable Angina: A New Meta-Analysis of Old Clinical Trials
2016, Scientific Reports