J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 12, December 2018, pages 868-876

The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

Figure 1. Rate of all-cause mortality in routine early revascularization (REV) versus selective late revascularization (SLR) in randomized controlled trials conducted in Europe and the United States. Boxes represent the weight/effect size for each study; the diamonds reflect the pooled combined effect from the meta-analysis.

Figure 2. Rate of myocardial infarction (MI) after index hospitalization in routine early revascularization (REV) versus selective late revascularization (SLR) in randomized controlled trials conducted in Europe and the United States. Boxes represent the weight/effect size for each study; the diamonds reflect the pooled combined effect from the meta-analysis.

Figure 3. Rate of coronary artery bypass grafting (CABG) in routine early revascularization (REV) versus selective late revascularization (SLR) in randomized controlled trials conducted in Europe and the United States. Boxes represent the weight/effect size for each study; the diamonds reflect the pooled combined effect from the meta-analysis.

**Table 1.** Baseline Characteristics of European and North American Trials [4-20]
	Authors	Follow-up	Patients in REV group	Patients in SLR group	Age (yrs)	Male (%)	Diabetes mellitus (%)	Hypertension (%)
REV: routine early revascularization; SLR: selective late revascularization.
European trials
FRISC-II [4]	Wallentin et al (2016)	15 years	1,222	1,235	66	72	13	30
RITA-3 [5]	Hernderson et al (2015)	10.6 years	895	915	63	61	15	35
ITALIAN ELDERLY ACS [15]	Savonitti et al (2012)	12 months	154	159	81.8	49	38	92
ICTUS [6]	Hoedemaker et al (2017)	10 years	604	596	62	74	14	37
ISAR COOL [16]	Neumann et al (2003)	1 month	203	207	70	66	26.1	85.5
LIPSIA NSTEMI [11]	Thiele et al (2011)	6 months	400	200	69	68	41	82
OPTIMA [19]	Riezebos et al (2009)	6 months	73	69	63	51	19	53
TRUCS [10]	Michalis et al (2000)	12 months	76	72	62	76	29	54
VINO [20]	Spacek et al (2002)	6 months	64	67	65.7	50	30	60
ABOARD [12]	Montalescot et al (2009)	1 month	175	177	65	72.6	21.7	65.7
ELISA [13]	van’t Hof et al (2003)	1 month	109	111	63	72	15	45
North American trials
MATE [7]	McCullough et al (1998)	21 months	111	90	57	77	11	-
OASIS 5 [9]	Swahn et al (2009)	24 months	92	92	68.2	74	14	62
TACTUS TIMI 18 [17]	Cannon et al (2001)	6 months	1,114	1,106	60	65	28	-
TIMACS [14]	Mehta et al (2009)	6 months	1,593	1,438	65	63.2	26.5	-
TIMI IIIB [18]	Anderson et al (1995)	12 months	740	733	-	66	-	-
VANQUISH [8]	Boden et al (1998)	23 months	462	458	62	97	24.9	56.7

Table 1. Baseline Characteristics of European and North American Trials [4-20]

Authors

Follow-up

Patients in REV group

Patients in SLR group

Age (yrs)

Male (%)

Diabetes mellitus (%)

Hypertension (%)

REV: routine early revascularization; SLR: selective late revascularization.

European trials

FRISC-II [4]

Wallentin et al (2016)

15 years

1,222

1,235

RITA-3 [5]

Hernderson et al (2015)

10.6 years

895

915

ITALIAN ELDERLY ACS [15]

Savonitti et al (2012)

12 months

154

159

81.8

ICTUS [6]

Hoedemaker et al (2017)

10 years

604

596

ISAR COOL [16]

Neumann et al (2003)

1 month

203

207

26.1

85.5

LIPSIA NSTEMI [11]

Thiele et al (2011)

6 months

400

200

OPTIMA [19]

Riezebos et al (2009)

6 months

TRUCS [10]

Michalis et al (2000)

12 months

VINO [20]

Spacek et al (2002)

6 months

65.7

ABOARD [12]

Montalescot et al (2009)

1 month

175

177

72.6

21.7

65.7

ELISA [13]

van’t Hof et al (2003)

1 month

109

111

North American trials

MATE [7]

McCullough et al (1998)

21 months

111

OASIS 5 [9]

Swahn et al (2009)

24 months

68.2

TACTUS TIMI 18 [17]

Cannon et al (2001)

6 months

1,114

1,106

TIMACS [14]

Mehta et al (2009)

6 months

1,593

1,438

63.2

26.5

TIMI IIIB [18]

Anderson et al (1995)

12 months

740

733

VANQUISH [8]

Boden et al (1998)

23 months

462

458

24.9

56.7

**Table 2.** Outcome Characteristics of European and North American Trials [4-20]
	Group	Index hospital revascularization (%)	Total revascularized patients (%)	Total deaths (%)	Cardiac deaths (%)	Repeat MI during follow-up (%)	Rehospitalization due to ischemic heart disease (%)	CABG(%)
European trials
FRISC [4]	REV	76	82	38.7	14.3	37.2	-	-
	SLR	14	58	39	16	45	-	-
RITA-3 [5]	REV	55	61	25.1	15.1	-	-	21
	SLR	10	38	25.4	16.1	-	-	4
ITALIAN ELDERLY ACS [15]	REV	56	58	12.3	10.4	7.1	16	7
	SLR	23	31	13.8	10.7	10.7	21	2.5
ICTUS [6]	REV	-	83	26.7	17.6	18.9	-	-
	SLR	-	61	23.7	15.2	14.9	-	-
ISAR COOL [16]	REV	78.3	-	0	-	6	-	7.9
	SLR	72	-	1.4	-	10.1	-	7.7
LIPSIA NSTEMI [11]	REV	84	-	5.2	-	2.2	28	10
	SLR	70	-	6.5	-	1	9	13
OPTIMA [19]	REV	-	100	1	-	3	18	-
	SLR	-	99	0	-	4	14	-
TRUCS [10]	REV	78	100	3.9	-	3.9	13	33
	SLR	38	61	12.5	-	4.2	17	18
VINO [20]	REV	-	73	3.1	-	3.1	2	35
	SLR	-	39	13.4	-	14.9	2	30
ABOARD [12]	REV	-	80.1	2.9	-	9.1	12	11
	SLR	-	69.5	1.1	-	4.5	18.6	11.3
ELISA [13]	REV	61	-	3	-	7	-	14
	SLR	58	-	5	-	6	-	19
North American trials (Canada/US)
MATE [7]	REV	58	72	11	-	6	23	18
	SLR	37	60	6	-	2	22	11
OASIS 5 [9]	REV	57.7	64	8.8	-	12.9	-	16
	SLR	30.4	51	2.2	-	13.3	-	12
TACTUS TIMI 18 [17]	REV	51	64	3.3	-	4.8	11	22
	SLR	36	45	3.5	-	6.9	13.7	16
TIMACS [14]	REV	74.4	93.1	4.8	-	4.8	1	14.8
	SLR	68.7	77.2	5.9	-	5.7	3.3	13.6
TIMI IIIB [18]	REV	6	64	8.8	-	16.3	26	30
	SLR	19	58	9.9	-	15.4	33	30
VANQUISH [8]	REV	44	-	17.3	-	15.6	-	20
	SLR	33	-	13	-	17.4	-	19

Table 2. Outcome Characteristics of European and North American Trials [4-20]

Group

Index hospital revascularization (%)

Total revascularized patients (%)

Total deaths (%)

Cardiac deaths (%)

Repeat MI during follow-up (%)

Rehospitalization due to ischemic heart disease (%)

CABG(%)

European trials

FRISC [4]

REV

38.7

14.3

37.2

SLR

RITA-3 [5]

REV

25.1

15.1

SLR

25.4

16.1

ITALIAN ELDERLY ACS [15]

REV

12.3

10.4

7.1

SLR

13.8

10.7

2.5

ICTUS [6]

REV

26.7

17.6

18.9

SLR

23.7

15.2

14.9

ISAR COOL [16]

REV

78.3

7.9

SLR

1.4

10.1

7.7

LIPSIA NSTEMI [11]

REV

5.2

2.2

SLR

6.5

OPTIMA [19]

REV

100

SLR

TRUCS [10]

REV

100

3.9

SLR

12.5

4.2

VINO [20]

REV

3.1

SLR

13.4

14.9

ABOARD [12]

REV

80.1

2.9

9.1

SLR

69.5

1.1

4.5

18.6

11.3

ELISA [13]

REV

SLR

North American trials (Canada/US)

MATE [7]

REV

SLR

OASIS 5 [9]

REV

57.7

8.8

12.9

SLR

30.4

2.2

13.3

TACTUS TIMI 18 [17]

REV

3.3

4.8

SLR

3.5

6.9

13.7

TIMACS [14]

REV

74.4

93.1

4.8

14.8

SLR

68.7

77.2

5.9

5.7

3.3

13.6

TIMI IIIB [18]

REV

8.8

16.3

SLR

9.9

15.4

VANQUISH [8]

REV

17.3

15.6

SLR

17.4