Fig 1.
Flow chart showing exclusion process during the literature review.
*non relevant systematic or non-systematic review **non relevant study protocol-wrong exposure. Abbreviations: NSTE-ACS: non ST elevation acute coronary syndrome; UA: unstable angina.
Table 1.
Summary of the studies included in the systematic review.
Table 2.
Characteristics of the randomised controlled trials included in the systematic review by Charytan et al [6].
Table 3.
Selected demographic and clinical characteristics of the cohort based study populations.
Table 4.
Selected demographic and clinical characteristics of the RCT based populations included in the meta-analysis by Charytan et al [6].
Fig 2.
Forest plot illustrating study specific effects for the association between an early invasive strategy and mortality compared with a conservative management strategy with results stratified by estimated glomerular filtration rate.
*the effect estimate presented is for those with an eGFR<60ml/minute/1.73m2 or the definition of kidney disease used within the specific study. For these studies results stratified further into subcategories of eGFR/CKD stages were not available. Results from the random effects meta-analysis conducted by Charytan et al are reported. The overall effect estimate for those with an eGFR<60ml/minute/1.73m2 is reported and then also results of the analysis further stratified by eGFR category (hollow diamonds). Results from the APPROACH study were reported overall for eGFR<60ml/minute/1.73m2 and also stratified by eGFR category (p-interaction by eGFR 0.624). Results from the EUPHORIC study were reported overall for eGFR<60ml/minute/1.73m2 and also stratified by eGFR category (p-interaction by eGFR 0.31). Results from the MINAP study were reported stratified by eGFR category (p-interaction by eGFR <0.001). Effect estimates for each of the studies included in the plot: ACSIS[8]- adjusted hazard ratio; CRUSADE[9]-adjusted odds ratio; APPROACH [13]-adjusted risk ratio; Charytan et al [6]- risk ratio; Tai (Taiwan ACS full spectrum registry) [14]-adjusted hazard ratio; CCP[10]- adjusted odds ratio; EUPHORIC [12]- adjusted odds ratio MINAP [4]–adjusted odds ratio. Abbreviations: EIS: early invasive strategy; ECS: early conservative strategy; ES: effect estimate; 95% CI: 95% confidence interval; TAIWAN ACS: TAIWAN ACS Full Spectrum Registry; ACSIS: Acute Coronary Syndromes Israeli Survey; CRUSADE: Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines; CCP: Cooperative Cardiovascular Project; FRISC II Fragmin and Fast Revascularization during Instability in Coronary Artery Disease; VINO: Value of first day angiography/ angioplasty In evolving Non-ST segment elevation myocardial infarction; TIMI IIIB: Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial; TACTICS TIMI18: The Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy; ICTUS: Invasive versus Conservative Treatment in Unstable Coronary Syndromes; EUPHORIC: European Public Health Outcome Research and Indicators Collection Project; APPROACH: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease; MINAP: Myocardial Ischaemia National Audit Project.
Fig 3.
Forest plot and meta-analysis across all stages of kidney function for the association between an early invasive strategy and mortality compared with a conservative management strategy with results stratified by estimated glomerular filtration rate.
Effect estimates for each of the studies included in the plot: ACSIS[8]- adjusted hazard ratio; CRUSADE[9]-adjusted odds ratio; APPROACH [13]-adjusted risk ratio; Charytan et al [6]- risk ratio; Tai (Taiwan ACS full spectrum registry) [14]-adjusted hazard ratio; CCP[10]- adjusted odds ratio; EUPHORIC [12]- adjusted odds ratio MINAP [4]–adjusted odds ratio. Abbreviations: EIS: early invasive strategy; ECS: early conservative strategy; ES: effect estimate; 95% CI: 95% confidence interval; TAIWAN ACS: TAIWAN ACS Full Spectrum Registry; ACSIS: Acute Coronary Syndromes Israeli Survey; CRUSADE: Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines; CCP: Cooperative Cardiovascular Project; FRISC II Fragmin and Fast Revascularization during Instability in Coronary Artery Disease; VINO: Value of first day angiography/ angioplasty In evolving Non-ST segment elevation myocardial infarction; TIMI IIIB: Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial; TACTICS TIMI18: The Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy; ICTUS: Invasive versus Conservative Treatment in Unstable Coronary Syndromes; EUPHORIC: European Public Health Outcome Research and Indicators Collection Project; APPROACH: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease; MINAP: Myocardial Ischaemia National Audit Project.
Fig 4.
Forest plot and meta-analysis of studies reporting results in those with an eGFR<30ml/minute/1.73m2 for the association between an early invasive strategy and mortality compared with a conservative management strategy with results stratified by estimated glomerular filtration rate.
Results from the APPROACH study were reported overall for eGFR<60ml/minute/1.73m2 and also stratified by eGFR category (p-interaction by eGFR 0.624). Results from the EUPHORIC study were reported overall for eGFR<60ml/minute/1.73m2 and also stratified by eGFR category (p-interaction by eGFR 0.31). Results from the MINAP study were reported stratified by eGFR category (p-interaction by eGFR <0.001). Effect estimates for each of the studies included in the plot: ACSIS[8]- adjusted hazard ratio; CRUSADE[9]-adjusted odds ratio; APPROACH [13]-adjusted risk ratio; Charytan et al [6]- risk ratio; Tai (Taiwan ACS full spectrum registry) [14]-adjusted hazard ratio; CCP[10]- adjusted odds ratio; EUPHORIC [12]- adjusted odds ratio MINAP [4]–adjusted odds ratio. Abbreviations: EIS: early invasive strategy; ECS: early conservative strategy; ES: effect estimate; 95% CI: 95% confidence interval; TAIWAN ACS: TAIWAN ACS Full Spectrum Registry; ACSIS: Acute Coronary Syndromes Israeli Survey; CRUSADE: Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines; CCP: Cooperative Cardiovascular Project; FRISC II Fragmin and Fast Revascularization during Instability in Coronary Artery Disease; VINO: Value of first day angiography/ angioplasty In evolving Non-ST segment elevation myocardial infarction; TIMI IIIB: Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial; TACTICS TIMI18: The Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy; ICTUS: Invasive versus Conservative Treatment in Unstable Coronary Syndromes; EUPHORIC: European Public Health Outcome Research and Indicators Collection Project; APPROACH: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease; MINAP: Myocardial Ischaemia National Audit Project.