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Emergency Heart Patients Do Better With Invasive Approach

Patients admitted to the hospital for sudden, worsening chest pain or a certain type of heart attack have better outcomes if they undergo early invasive treatment// rather than being treated conservatively, a new review of clinical trials has found.

“Available evidence suggests that an early invasive strategy is superior to a conservative strategy,” said lead author Michel Hoenig of the Centre for Research in Vascular Biology at the University of Queensland in Australia. “However, we are far from having as solid an answer as we need given the prevalence and costs associated with treating this disease.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The researchers looked at two heart conditions: unstable angina, which is acute, accelerating chest pain, and a kind of heart attack known as non-ST-elevation myocardial infarction, which is diagnosed in part by ECG.

Together, these conditions account for 1.4 million hospital admissions yearly in the United States, far surpassing admissions for other cardiac disorders. Although the risks of death, heart attack and other unfavorable outcomes vary widely among patients with these disorders, cardiologists classify them as a single acute coronary syndrome.

The Cochrane reviewers pooled findings from five major randomized controlled trials that compared an early invasive approach to a conservative approach in patients with this acute coronary syndrome.

They looked at differences in the death and heart attack rates both during the initial hospitalization and in the long term. They also looked at differences in rates of intractable angina and rehospitalization dur
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