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Long-Term Outcome o...
Long-Term Outcome of a Routine Versus Selective Invasive Strategy in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome A Meta-Analysis of Individual Patient Data
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Fox, Keith A. A. (author)
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Clayton, Tim C. (author)
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Damman, Peter (author)
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Pocock, Stuart J. (author)
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de Winter, Robbert J. (author)
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Tijssen, Jan G. P. (author)
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- Lagerqvist, Bo, 1952- (author)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
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(creator_code:org_t)
- Elsevier BV, 2010
- 2010
- English.
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In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 55:22, s. 2435-2445
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
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- OBJECTIVES: This study was designed to determine: 1) whether a routine invasive (RI) strategy reduces the long-term frequency of cardiovascular death or nonfatal myocardial infarction (MI) using a meta-analysis of individual patient data from all randomized studies with 5-year outcomes; and 2) whether the results are influenced by baseline risk. BACKGROUND: Pooled analyses of randomized trials show early benefit of routine intervention, but long-term results are inconsistent. The differences may reflect differing trial design, adjunctive therapies, and/or limited power. This meta-analysis (n = 5,467 patients) is designed to determine whether outcomes are improved despite trial differences. METHODS: Individual patient data, with 5-year outcomes, were obtained from FRISC-II (Fragmin and Fast Revascularization during Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Trial of a Conservative Treatment Strategy Versus an Interventional Treatment Strategy in Patients with Unstable Angina) trials for a collaborative meta-analysis. A Cox regression analysis was used for a multivariable risk model, and a simplified integer model was derived. RESULTS: Over 5 years, 14.7% (389 of 2,721) of patients randomized to RI strategy experienced cardiovascular death or nonfatal MI versus 17.9% (475 of 2,746) in the selective invasive (SI) strategy (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.71 to 0.93; p = 0.002). The most marked treatment effect was on MI (10.0% RI strategy vs. 12.9% SI), and there were consistent trends for cardiovascular deaths (HR: 0.83, 95% CI: 0.68 to 1.01; p = 0.068) and all deaths (HR: 0.90, 95% CI: 0.77 to 1.05). There were 2.0% to 3.8% absolute reductions in cardiovascular death or MI in the low and intermediate risk groups and an 11.1% absolute risk reduction in highest risk patients. CONCLUSIONS: An RI strategy reduces long-term rates of cardiovascular death or MI and the largest absolute effect in seen in higher-risk patients.
Keyword
- acute coronary syndrome
- percutaneous coronary intervention
- interventional strategy
- MEDICINE
- MEDICIN
Publication and Content Type
- ref (subject category)
- art (subject category)
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Fox, Keith A. A.
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Clayton, Tim C.
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Damman, Peter
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Pocock, Stuart J ...
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de Winter, Robbe ...
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Tijssen, Jan G. ...
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show more...
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Lagerqvist, Bo, ...
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Wallentin, Lars, ...
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Uppsala University