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In NSTEACS, is an early invasive strategy (within 24 hours) useful for all the patients and not only for those at high risk ?

In NSTEACS, is an early invasive strategy (within 24 hours) useful for all the patients and not only for those at high risk ?

Yes 47%
No 53 %

 

Acute Coronary Syndromes (ACS)


The recent NSTEMI guidelines (Hamm et al., Eur Heart J 2011) ask for a quick diagnostic angiography in all patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

This is a clear modification compared to the myocardial revascularization guidelines (Wijns et al. Eur Heart J 2010) and the PCI-guidelines published before (Silber et al. Eur Heart J 2005), which asked for 48 hours and 72 hours,
respectively.

Particularly, it is essential to stay within 24 hours of diagnosis in patients with high-risk NSTE-AC (ST-segment deviation, rhythm disturbances, ongoing symptoms, increase in troponin, hemodynamical deterioriation). If the organization of the diagnostic angiogram +/- percutaneous intervention If necessary) is not possible within 24 hours in moderate-to-lower risk patients with NSTE-ACS due to the lack of open catheter laboratories, 48 hours might be acceptable but should not be the primary goal

Conclusion:

This findings of the poll are surprising because the randomised trial evidence and the guidelines specifically support early intervention in higher- risk patients

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.