All included studies had a Jaded score of 3. Randomisation was described as appropriate and follow-up described as complete in all trials.
Contemporary trials with stents
Five RCTs were included (n=1,235). Routine early invasive strategy was associated with a significant reduction in all-cause mortality (OR 0.55, 95% CI: 0.34, 0.90, p=0.02), absolute risk reduction 2.8 per cent, number needed to treat 36) and reinfarction (OR 0.53, 95% CI: 0.33, 0.86, absolute risk reduction 2.7 per cent, number needed to treat 37). There was no significant difference in the risk of stroke or in-hospital major bleeding. There was no statistically significant heterogeneity detected. Sensitivity analysis did not detect a disproportionate influence by any trial.
Older balloon angioplasty trials
Four RCTs were included (n=4,612). Early invasive strategy with balloon angioplasty was associated with a significant increase in major bleeding (OR 1.35, 95% CI: 1.13, 1.61, p=0.001). There was no significant difference in the incidence of all-cause mortality, reinfarction or stroke. Results of tests for heterogeneity and sensitivity analyses were not discussed for this secondary analysis.