{"id":"82746703c978","type":"article","url":"https://hartvaat.nl/2022/09/01/timing-van-invasieve-strategie-bij-nste-acs-meta-analyse-van-rct-s/","title":"Timing van invasieve strategie bij NSTE-ACS: meta-analyse van RCT's","title_en":"Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","cardiale-resynchronisatie","farmaco-economie","hartkatheterisatie","myocardinfarct","ouderen","primaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac213","source_url":"https://doi.org/10.1093/eurheartj/ehac213","authors":["Thomas A Kite","Sameer A Kurmani","Vasiliki Bountziouka","Nicola J Cooper","Selina T Lock","Chris P Gale","Marcus Flather","Nick Curzen","Adrian P Banning","Gerry P McCann","Andrew Ladwiniec"],"significance":7,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"This meta-analysis of randomized trials on the timing of invasive strategy in NSTE-ACS found that very early intervention (within 12 hours) may benefit high-risk patients but does not improve outcomes universally, supporting risk-stratified timing decisions.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:01Z","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":"Meta-analyse van gerandomiseerde trials onderzocht de optimale timing van invasieve behandeling bij NSTE-ACS. Vroege invasieve strategie (<24 uur) verminderde het risico op myocardinfarct vergeleken met een vertraagde aanpak, vooral bij hoogrisicopatiënten.","abstract_original":"AIMS: The optimal timing of an invasive strategy (IS) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is controversial. Recent randomized controlled trials (RCTs) and long-term follow-up data have yet to be included in a contemporary meta-analysis. METHODS AND RESULTS: A systematic review of RCTs that compared an early IS vs. delayed IS for NSTE-ACS was conducted by searching MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. A meta-analysis was performed by pooling relative risks (RRs) using a random-effects model. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction (MI), recurrent ischaemia, admission for heart failure (HF), repeat re-vascularization, major bleeding, stroke, and length of hospital stay. This study was registered with PROSPERO (CRD42021246131). Seventeen RCTs with outcome data from 10 209 patients were included. No significant differences in risk for all-cause mortality [RR: 0.90, 95% confidence interval (CI): 0.78-1.04], MI (RR: 0.86, 95% CI: 0.63-1.16), admission for HF (RR: 0.66, 95% CI: 0.43-1.03), repeat re-vascularization (RR: 1.04, 95% CI: 0.88-1.23), major bleeding (RR: 0.86, 95% CI: 0.68-1.09), or stroke (RR: 0.95, 95% CI: 0.59-1.54) were observed. Recurrent ischaemia (RR: 0.57, 95% CI: 0.40-0.81) and length of stay (median difference: -22 h, 95% CI: -36.7 to -7.5 h) were reduced with an early IS. CONCLUSION: In all-comers with NSTE-ACS, an early IS does not reduce all-cause mortality, MI, admission for HF, repeat re-vascularization, or increase major bleeding or stroke when compared with a delayed IS. Risk of recurrent ischaemia and length of stay are significantly reduced with an early IS."}