Appropriate invasive and conservative strategies for patients with non-ST elevation acute coronary syndromes

Purpose of review: This review focuses on recent developments in three controversial areas of management of acute coronary syndromes. Recent findings: There are potential benefits of an early invasive treatment strategy (routine cardiac catheterization and revascularization when appropriate) in the elderly, who are at high risk for adverse outcomes and treatment-related complications following acute coronary syndromes. There are developments in the role of low-molecular-weight heparin agents in management of acute coronary syndromes in the modern treatment era, in which early coronary revascularization and use of other potent antiplatelet and antithrombin agents are common. Finally, this review looks at emerging data and controversy regarding the effects of intensive lipid-lowering treatment early after acute coronary syndrome. Recent clinical trials have yielded contradictory results. Summary: This paper evaluates recent evidence in acute coronary syndromes regarding early invasive revascularization strategies in high risk elderly patients, and also discusses controversies regarding the role of low molecular weight heparin and intensive statin regimens.