ReviewHow should patients with unstable angina and non-ST-segment elevation myocardial infarction be managed? A meta-analysis of randomized trials
Section snippets
Methods
We searched the MEDLINE and EMBASE databases (Ovid Technologies, 1966-September 2003; English language) for keywords related to acute coronary syndromes (eg, coronary artery disease, myocardial infarction, unstable angina), medical therapy (eg, platelet aggregation inhibitor, antithrombotic, thrombolysis), interventional therapy (eg, angioplasty, percutaneous transluminal coronary angioplasty, coronary angiography), and risk stratification. Two investigators independently reviewed the search
Trial characteristics and methodological quality
Our initial search yielded 382 citations, of which 328 articles were excluded on the basis of an abstract review. Of the remaining 54 references, 42 were excluded because they reported trials that enrolled patients with ST-segment elevation MI, did not report the results of a clinical trial, were duplicate publications, described studies that only randomized patients with cardiogenic shock or high risk post-MI patients, were not published in English, or did not fulfill inclusion criteria for
Discussion
This meta-analysis demonstrates that when compared with a conservative strategy, an invasive management strategy reduces rates of re-hospitalization and the combined endpoint of fatal and nonfatal re-infarction for patients with unstable angina and non-ST-elevation MI. A nonsignificant trend favoring an invasive strategy for reducing the composite endpoint of death or nonfatal re-infarction was also observed, but there was no advantage of either strategy with respect to all-cause mortality or
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