According to the European Society of Cardiology (ESC Guidelines 2021) an early invasive strategy is recommended (<24h) for high-risk patients with acute coronary syndrome with no ST elevation (NSTE-ACS), namely patients presenting a rise or fall in cardiac troponin, dynamic ST- or T-wave changes and GRACE risk score >140. Early intervention (<2h) is reserved for…
Invasive Strategy in Frail Patients Is Safe
Courtesy of Dr. Carlos Fava. The current population of frail and elderly patients is increasing, and while non-ST-segment acute coronary syndrome (NSTEACS) guidelines recommend early invasive treatment, this group has been excluded from most studies on the subject. Current information on its efficacy is controversial but agrees with the notion that this is a higher-risk group…
Early Invasive Strategy Benefits High-Risk Patients
Early angiography is not associated with a reduction in mortality compared with a more delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, a new meta-analysis published by The Lancet supports the idea that certain high-risk patients would benefit from it. Patients with elevated cardiac biomarkers, a high GRACE score, diabetes, or advanced…
Follow-up at 10 years for invasive vs. conservative strategy for non-ST-segment elevation infarction
The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), with elevated markers such as cardiac troponin T. The absence of long-term benefit of an early invasive strategy at 1 and 5 years had already been reported.…