Early versus Delayed Invasive Intervention in Acute Coronary Syndromes

In patients with acute coronary syndromes, early invasive intervention (coronary angiography at a median of 14 hours) was compared with delayed intervention (angiography at a median of 50 hours). There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia. There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia. Randomized trials have shown that a routine invasive strategy is beneficial in high-risk patients with acute coronary syndromes. 1 – 3 In patients with myocardial infarction with ST-segment elevation, in which the infarct-related artery is usually occluded and there is ongoing transmural ischemia, it is well established that the earlier primary percutaneous coronary intervention (PCI) can be performed, the lower the mortality. 4 , 5 By contrast, in patients with acute coronary syndromes without ST-segment elevation (including unstable angina and myocardial infarction), the culprit artery is often patent, there is usually no ongoing transmural ischemia, and the patient often has a good response to . . .