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Randomised controlled trial
Early invasive strategy in patients with non-ST segment elevation acute coronary syndrome delays death or MI by 18 months
  1. Robert Henderson
  1. Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
  1. Correspondence to: Dr Robert Henderson, Trent Cardiac Centre, Nottingham University Hospitals, City Hospital Campus, Hucknall Road, Nottingham, NG51PB, UK; robert.henderson{at}

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Commentary on: Wallentin L, Lindhagen L, Ärnström E, et al. Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study. Lancet 2016;388:1903–11.


The role of coronary arteriography in patients with non-ST segment elevation acute coronary syndrome is controversial. Many cardiologists advocate a ‘routine invasive strategy’, which comprises coronary arteriography within a few days of presentation and myocardial revascularisation determined by the angiographic findings, but this exposes patients to procedural risks and incurs significant costs. Other clinicians favour a ‘selective invasive strategy’, with coronary arteriography reserved for patients with recurrent myocardial ischaemia.

Randomised trials of these treatment strategies suggest that a routine invasive strategy reduces the risk of recurrent ischaemia and death or recurrent myocardial infarction over 5 years.1 In the RITA-3 trial, a routine invasive strategy was also associated with lower cardiovascular …

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  • Competing interests The author is a Member of the Executive Committee of the The British Heart Foundation RITA-3 Randomised Trial, a Member of the NICE Guideline Development Group for Clinical Guideline 94 Unstable angina and NSTEMI: early management and a Member of an Advisory Board for Creavo Medical Technologies.

  • Provenance and peer review Commissioned; internally peer reviewed.