Author Affiliations: Harvard Clinical Research Institute and the Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Mass.
Acute coronary syndromes (ACSs) account for approximately 1.4 million
hospitalizations each year in the United States alone, and more than 2 million
worldwide.1 Until recently, however, there
was no consistent guidance as to how such patients should be optimally managed
during the hospital phase. Some clinicians favored an early invasive strategy,
with cardiac catheterization during the first 24 to 48 hours of presentation.
Others favored a more conservative strategy with initial medical stabilization
followed by cardiac catheterization only if the patient demonstrated high-risk
features (such as recurrent myocardial ischemia or congestive heart failure)
or significant myocardial ischemia on noninvasive testing. Although the invasive
strategy offers the ability to identify patients with high-risk coronary anatomy
quickly and definitively, several clinical trials suggested that these potential
benefits were offset by the early risks of revascularization procedures in
these high-risk subgroups.2,3
Cohen DJ. Invasive vs Conservative Management of Acute Coronary SyndromesDo the Data Support the Guidelines?. JAMA. 2002;288(15):1905-1907. doi:10.1001/jama.288.15.1905