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Early invasive strategy should be performed within 72 hours in high-risk patients with non-ST-elevation myocardial infarction
  1. Carlos Collet1,
  2. Patrick W Serruys2
  1. 1 Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, North Holland, The Netherlands
  2. 2 Department of Cardiology, Imperial College London, London, UK
  1. Correspondence to Professor Patrick W Serruys, Department of Cardiology, Imperial College London, London SW7 2AZ, UK; patrick.w.j.c.serruys{at}gmail.com

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Commentary on: Jobs A, Mehta SR, Montalescot G, et al. Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials. Lancet 2017;390:737–46.

Context

The mainstay of treatment for patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) is medical therapy, early coronary angiography and revascularisation. A routine invasive strategy has been shown to reduce all-cause death and myocardial infarction  compared with a conservative approach at 5 years.1 Therefore, an early invasive strategy with intent to perform revascularisation is advocated in the 2014 American and European guidelines with a class I recommendation.2 3 While immediate angiography is recommended for extremely high-risk patients (eg, haemodynamic or electrical instability, persistent angina, heart failure or worsening mitral regurgitation), the optimal timing for an invasive approach in patients …

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