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October 16, 2002

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

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

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