Early invasive strategies for acute coronary syndromes.

Early coronary angiography and percutaneous or operative revascularization is now the treatment of choice for both ST- and non-ST-segment elevation acute coronary syndromes (ACS). In non-ST-segment elevation ACS this strategy produces a 18% to 22% reduction in ischemic outcomes at 6 months and prevents 1.7 deaths, 2.0 nonfatal infarcts and 20 readmissions per 100 treated patients at 1-year follow-up. Early angiography allows definition of coronary anatomy and assessment of left ventricular function, both important predictors of long-term risk. Intracoronary stenting and intravenous glycoprotein IIb/IIIa antagonists have improved outcome in percutaneous revascularization and should be used in the majority of ACS patients undergoing PCI. Initial costs are higher with an early invasive strategy; however, these are offset by reductions in rehospitalizations and later ischemic complications.