Author Affiliation: Cleveland Clinic Foundation,
Department of Cardiovascular Medicine, Cleveland, Ohio.
Unstable angina and non–ST-segment elevation myocardial infarction,
the most frequent manifestations of acute coronary syndromes (ACS), remain
common reasons for hospital admission. Despite advances in therapy, ACS are
associated with substantial morbidity and mortality. Throughout the 1990s,
a debate raged within the cardiology community about whether an “invasive”
approach was superior to a “conservative” approach in the initial
management of ACS. The invasive approach implied a strategy of routine cardiac
catheterization, whereas a conservative approach reserved catheterization
for recurrent spontaneous or stress-induced ischemia. However, an invasive
strategy does not always result in revascularization, nor does a conservative
strategy necessarily imply no catheterization. Nevertheless, in a philosophical
sense, these 2 approaches had been viewed as polar opposites.
Bhatt DL. To Cath or Not to CathThat Is No Longer the Question. JAMA. 2005;293(23):2935-2937. doi:10.1001/jama.293.23.2935