Management of non-ST-elevation myocardial infarction: A constant challenge

Growing recognition of the heterogeneity of clinical conditions associated with non-ST-elevation myocardial infarction (NSTEMI) has led to intense research on this entity in a search for the best therapeutic options.NSTEMI is associated with higher rates of morbidity and mortality than other acute coronary syndromes (ACS) 1 and thus warrants thorough study.The article by Gonzales-Cambeiro et al. 2 published in this issue of the Journal on the mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) after successful percutaneous coronary intervention (PCI) in NSTEMI gives this question a new impulse.The authors of this observational study showed that in NSTEMI patients successfully treated by PCI, the use of ACEIs/ARBs was associated with a lower risk of four-year mortality.However, the high rate of multivessel disease, lack of information on the proportion of patients who underwent complete revascularization and on how soon PCI was performed, and the fact that the population was not stratified according to clinical severity by criteria such as the GRACE score, highlight certain variables that require