Journal club 14 March 2012

Article:


Timing of Angiography With a Routine Invasive Strategy and Long-Term Outcomes in Non–ST-Segment Elevation Acute Coronary Syndrome

Presenter

FS

PICO

Population:

Meta-analysis combing patients from FRISC II, ICTUS and RITA-3 trial. The purpose of the paper was to assess the relationship of time to angiography (from randomisation and not to intervention) long term outcome (5 year) of patients assigned to routine invasive angiography

Intervention

The purpose of this paper was to examine the relationship between time to angiography (not revascularisation) from randomisation and long term clinical outcome in patients chosen for invasive strategy by aggregating three clinical trials of the invasive strategy in non-ST elevation acute coronary syndrome.

Comparator

Outcome

In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN07752711)

Discussion

Summary

  • The differences of the trials was noted, particularly the time distributions of angiography. This limited the inferences from the aggregation.
  • Time to angiography was not randomised or mandated. There are a number of confounding factors which could have affected the outcomes. Although inverse probability weighting was used in the Cox proportional hazard modeling, there were significant concerns regarding the meaning of the analysis
  • The definitional issues between trials, particularly of myocardial infarction were noted as particularly problematic.

 

 

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