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June 15, 2005

To Cath or Not to Cath: That Is No Longer the Question

Author Affiliations

Author Affiliation: Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, Ohio.

JAMA. 2005;293(23):2935-2937. doi:10.1001/jama.293.23.2935

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.