Debating early invasive versus medical management
When there is an apparent threat of myocardial damage from unstable angina or non-ST-elevation myocardial infarction (NSTEMI) (collectively referred to as the non-ST-elevation acute coronary syndromes, or NSTEACS), early opening of the culprit atherothrombotic coronary artery would seem logical. Clinical trials of early coronary intervention (the invasive approach) have shown variable results when applied to all patients with NSTEACS, but clear benefits when applied to high-risk patients.1,2
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I have received royalties from Churchill Livingstone/Elsevier for the textbook Coronary care manual. I have also received speaker fees from Merck Sharp & Dohme, Schering-Plough, Pfizer, AstraZeneca and Solvay, and reimbursement of travel expenses from AstraZeneca and Pfizer.