SynthesisLancet (London, England)2017
Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.
Synthesis in Lancet (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
90 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Circulating microRNA-1 as a diagnostic biomarker for acute myocardial infarction: a meta-analysis.Cardiology journal · 2025Pooled it
- Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis.European heart journal · 2024Pooled it
- Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Pooled it
- Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.Archivos de cardiologia de Mexico · 2024Guideline
- Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials.European heart journal · 2022Pooled it
- Early invasive strategy for non-ST elevation acute coronary syndrome: a meta-analysis of randomized, controlled trials.The Journal of international medical research · 2020Pooled it
- Pooled it
- Comparison of Immediate Versus Staged Complete Revascularization in Patients With Index PCI Coronary Complications: A Study on Clinical Outcomes and Predictors of Complications.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026Trial
- Trial
- Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial.Heart (British Cardiac Society) · 2024Trial
- Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial.Journal of the American Heart Association · 2021Trial
- Absence of chest discomfort in type 1 NSTEMI patients: predictors and impact on outcome.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Helicopter emergency medical services for interfacility transfers: an Italian expert consensus.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Radial versus femoral access for coronary angiography and percutaneous coronary interventions in critically ill patients.Journal of anesthesia, analgesia and critical care · 2026Article
- Contemporary Data on Sex Differences in Coronary Angiography Findings: A Dual-Nation Study.JACC. Advances · 2026Article
- A Comprehensive Review of Acute Coronary Syndrome and Bypass Surgery: Recent Advances, Timing, and Indicative Considerations.Journal of clinical medicine · 2026Review
- Comparison of Clinical Outcomes Between Early and Delayed Percutaneous Coronary Intervention for the Culprit Lesion in Patients with Non-ST-segment Elevation Myocardial Infarction.Internal medicine (Tokyo, Japan) · 2025Article
- Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome With Congestive Heart Failure - A Systematic Review and Meta-Analysis.Circulation reports · 2025Article
- Timing of invasive strategy in patients with non-ST segment elevation acute myocardial infarction: A nationwide retrospective cohort analysis.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2025Article
30 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality.
methodsWe identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988).
findingsWe included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180-360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64-1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581-0·996), diabetes (0·67, 0·45-0·99), a GRACE risk score more than 140 (0·70, 0·52-0·95), and aged 75 years older (0·65, 0·46-0·93), although tests for interaction were inconclusive.
interpretationAn early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients.
fundingNone.
Indexed as
Identifiers
28778541What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.