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To the Editor: The meta-analysis by Dr Mehta and colleagues¹ suggested a beneficial effect from a routine invasive coronary strategy compared with a selective invasive strategy in patients with NSTE ACS over a follow-up of about one and one-half years. The accompanying Editorial² discussed the need to consider coronary angiography in patients with NSTE ACS.

The meta-analysis was based on 7 articles. The conclusion was that compared with a selective invasive approach, a routine invasive approach did not improve overall mortality but did improve rates of nonfatal myocardial infarction (MI) and the combined outcomes of death and nonfatal MI. This effect was seen most strongly in 2 studies, FRISC II³ and VINO.⁴ These findings are similar to those of another meta-analysis of the same 7 studies.⁵

However, there were several design limitations in the individual trials that deserve further consideration before a routine invasive approach is embraced in patients with . . . [Full Text of this Article]

Enrique V. Carbajal, MD
enrique.carbajal@va.gov
Veterans Affairs Central California Health Care System
Fresno, Calif

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