The use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for myocardial infarction compared with conservative invasive approach, according to a retrospective cohort study published in Annals of Internal Medicine. However, the authors of an accompanying editorial suggest that more research is needed before clinicians change practice.
Clinical trials have shown that an early invasive strategy for acute coronary syndromes is associated with better outcomes than a conservative approach. Using national health care data from Denmark, researchers sought to determine if this would be true in real world practice. The researchers compared outcomes for patients hospitalized for the first time with acute coronary syndromes who had a diagnostic coronary angiography within 72 hours (early invasive treatment strategy) with those who had coronary angiography more than 3 days later or not at all (conservative invasive approach).
The researchers found evidence that an early invasive approach was associated with a decreased risk for adverse cardiac events, including cardiac death. However, the study has weaknesses with regard to the quality of patient data and strength of analytic methods. For now, the editorialists caution that clinical practice should not be influenced by comparative effectiveness studies using observational data.
The research can be viewed here.
The editorial can be viewed here.