Key result
A routine invasive strategy for NSTE-ACS reduces long-term rates of cardiovascular death or MI compared to a conservative approach, but the optimal timing of intervention remains unestablished.
This editorial refers to ‘Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study’, by Lindholm et al. doi:10.1093/ehjqcco/qcw044 ‘Never leave that till tomorrow which you can do today.’ ―Benjamin Franklin (1706–1790) To provide some clarity, multiple studies compared a routine invasive strategy to a more conservative, ischaemia-guided approach. A meta-analysis of these studies demonstrated that a routine invasive strategy reduced long-term rates of cardiovascular death or MI, with the largest absolute effect seen in higher risk patients.3 These findings have resulted in a Class IA recommendation for an invasive approach for the treatment of NSTE-ACS in intermediate and high-risk patients in the latest European Society of Cardiology guidelines.4 However, the optimal timing of invasive coronary angiography and potential revascularization in these patients has not yet been established.
No takes yet. Share an insight, caveat, or question.
Joseph et al. (2016) conducted an editorial in non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Routine invasive strategy vs. Conservative, ischaemia-guided approach was evaluated. A routine invasive strategy for NSTE-ACS reduces long-term rates of cardiovascular death or MI compared to a conservative approach, but the optimal timing of intervention remains unestablished.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: