Is early invasive treatment superior to selectively invasive treatment in patients with acute coronary syndromes?
Michel E Bertrand
Correspondence Hôpital Cardiologique, Boulevard du Pr Leclercq, 59037 Lille, France
Email mbertrand@cardiolille.net
This article has no abstract so we have provided the first paragraph of the full text.
Over past 10 years, ACS have become a major healthcare problem, with millions of patients being hospitalized annually. Guidelines for the management of patients presenting with non-ST-segment elevation ACS were published in 2000 by the European Society of Cardiology (ESC), the American College of Cardiology (ACC) and the American Heart Association (AHA), and were updated in 2002.1, 2 These guidelines recommend an invasive strategy for high-risk patients presenting with ACS, which means systematic angiography and, where indicated, revascularization performed using percutaneous coronary intervention or coronary artery bypass grafting surgery. This strategy was devised based upon results from five clinical trials that compared interventional (invasive) treatment with conservative (noninvasive) treatment. The TIMI IIIB and VANQWISH trials were performed before the era of coronary stenting; the findings from these trials are now therefore obsolete. FRISC II,3 TACTICS4 and RITA 3, however, demonstrated the benefit of an invasive strategy.
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