Two different treatment strategies, termed "early conservative" and "early invasive," have evolved for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). In the early conservative strategy, coronary angiography is reserved for patients with evidence of recurrent ischemia (angina at rest or with minimal activity or dynamic ST-segment changes) or a strongly positive stress test, despite vigorous medical therapy. In the early invasive strategy, patients without clinically obvious contraindications to coronary revascularization are routinely recommended for coronary angiography and angiographically directed revascularization if possible. Although some contemporary studies have found mortality benefits with an early invasive strategy in patients with ACS, others have shown no benefit, and older studies have suggested increased hazards with this approach. Based on the available data, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend an early invasive approach, although the writing committee noted, "As a general principle, the potential benefits of coronary angiography and revascularization must be carefully weighed against the risks and the conflicting results of the clinical trials and registries." In an effort to systematically determine whether early invasive therapy improves survival and reduces adverse cardiac events, Bavry et al. conducted a meta-analysis of trials using contemporary therapies. This article, prepared by Anthony A. Bavry, MD, MPH, summarizes the results of this study.
|Original language||English (US)|
|Number of pages||4|
|Journal||ACC Cardiosource Review Journal|
|State||Published - Dec 1 2006|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine