{"id":"a15989ebb6fa","type":"article","url":"https://hartvaat.nl/2017/08/19/optimale-timing-van-invasieve-strategie-bij-nste-acs-lancet-meta-analyse/","title":"Optimale timing van invasieve strategie bij NSTE-ACS: Lancet meta-analyse","title_en":"Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31490-3","source_url":"https://doi.org/10.1016/S0140-6736(17)31490-3","authors":["Alexander Jobs","Shamir R Mehta","Gilles Montalescot","Eric Vicaut","Arnoud W J Van't Hof","Erik A Badings","Franz-Josef Neumann","Adnan Kastrati","Alessandro Sciahbasi","Paul-Georges Reuter","Frédéric Lapostolle","Aleksandra Milosevic","Goran Stankovic","Dejan Milasinovic","Reinhard Vonthein","Steffen Desch","Holger Thiele"],"significance":8,"published":"2017-08-19","source_date":"2017-08-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"This Lancet meta-analysis of randomized trials examined the optimal timing of invasive strategy in non-ST-elevation ACS, finding that very early intervention (within 24 hours) reduced recurrent ischemia in high-risk patients but did not significantly reduce death or MI compared with delayed intervention.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet meta-analyse van gerandomiseerde trials naar de optimale timing van een invasieve strategie bij NSTE-ACS. Vroegtijdige versus uitgestelde invasieve benadering.","abstract_original":"BACKGROUND: A 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. METHODS: We 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). FINDINGS: We 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. INTERPRETATION: An 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. FUNDING: None."}