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November 2026 Br J Cardiol 2026;33(4) doi:10.5837/bjc.2026.055 Online First

Early versus delayed invasive strategy in NSTE-ACS: an updated systematic review and meta-analysis of RCTs

Aditya Mukherjee, Andrew Ladwiniec, Gerry P McCann, Amitha Puranik, Coral Pepper, Thomas A Kite

Abstract

Introduction Over the past two decades, many randomised-controlled trials (RCTs) have compared the efficacy of an early invasive strategy (IS) against a delayed IS in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). However, uncertainty about the optimum timing of IS remains. The largest meta-analysis to investigate timing of invasive treatment included 17 RCTs (>10,000 patients) and was published in 2022.1 It did not show a reduction in all-cause mortality, myocardial infarction (MI), repeat revascularisation or admission with heart failure (HF) with early IS, but recurrent ischaemia and length of stay were reduc

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