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We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD8). We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180–360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 081, 95% CI 064–103; p=00879).

In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0761, 95% CI 0581–0996), diabetes (067, 045–099), a GRACE risk score more than 140 (070, 052–095), and aged 75 years older (065, 046–093), although tests for interaction were inconclusive.

Meet Nathan Byrn... He's half White Witch, half Black Witch. His mother was a healer, his father is a killer. He's been kept in a cage since he was fourteen. But if White Witches are good and Black Witches are evil, what happens if you are both? 'A book about witches with no owls and not a pair of round spectacles in sight.

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