Study designs of evaluations included in the review
Only randomised controlled trials (RCTs) were included in the review.
Specific interventions included in the review
Studies that compared early invasive therapy for the management of non-ST-segment elevation with a more conservative approach were eligible for inclusion. In addition, eligible studies had to ensure that glycoprotein IIb/IIIa inhibitors and/or thienopyridines and coronary stents were available for use during percutaneous coronary intervention (PCI). All of the included patients received aspirin and either unfractionated or low molecular weight heparin. Glycoprotein inhibitors were available during PCI and medical stabilisation in all but 3 trials; thienopyridines were used in all trials of PCI. All invasively treated patients were treated in catheterisation laboratories and continued medical treatment or underwent PCI or coronary artery bypass grafting, dependent on coronary anatomy. The majority of conservatively treated patients received antiplatelet and antithrombin agents; if symptoms persisted or in the event of haemodynamic or electrical instability or a large ischaemic burden on pre-discharge stress testing, patients were treated in the catheterisation laboratory.
Participants included in the review
Studies of patients with a diagnosis of NSTE-ACS were eligible for inclusion. Patients who had chronic stable angina or with ST-segment elevation myocardial infarction (MI), and who used fibrinolytic agents were excluded from the review. The mean or median age of the included participants ranged from 62 to 70 years; 27 to 39% were women; 12 to 39% had diabetes; 22% to 39% had had a previous MI; and 21 to 41% were current smokers.
Outcomes assessed in the review
The primary outcome assessed in the review was all-cause mortality. The secondary end points included nonfatal MI, recurrent unstable angina that required rehospitalisation and the rate of revascularisation.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.