Optimal timing of invasive management of NSTE-ACS

Coronary heart disease remains one of the biggest causes of death in the UK ( Townsend et al, 2015 ). Acute coronary syndrome (ACS) is a term used to describe a range of clinical manifestations attributed to coronary heart disease ( Hamm et al, 2011 ). The need for prompt treatment and management of ST-elevation-ACS (STE-ACS) is unambiguous and, in the UK, these patients follow a well-established route from diagnosis, often in the pre-hospital setting, straight into a cardiac catheter laboratory for coronary assessment and revascularisation within 120 minutes ( National Institute for Health and Care Excellence (NICE), 2013 ). Although non-ST-elevation-ACS (NSTE-ACS) patients have a lower 30-day mortality rate than STE-ACS patients, at 1 year, the incidence of refractory angina, re-admission to hospital and mortality is significantly higher ( Meier and Seiler, 2013 ). Despite conflicting opinions from international working groups, the optimal timing of invasive management for this cohort of patients remains a contentious matter. By examining contemporary literature, this article aims to explore the available evidence into the optimal timing of invasive coronary intervention for NSTE-ACS patients.