ACUTE CORONARY SYNDROMS WITHOUT ST SEGMENT ELEVATION. INVASIVE STRATEGY: THE BEST CHOICE

Abstract
The initial management of unstable angina and non ST segment elevation myocardial infarction deserve special emphasis regarding the choice of an early invasive or conservative strategy. An early invasive strategy is currently recommended for patients with unstable angina and non ST segment elevation myocardial infarction with moderate to high risk features. Whether patients with acute coronary syndromes should undergo an early invasive or conservative management strategy had been controversial because the conflicting results of the early clinical trials (TIMI-IIIB, MATE, VANQWISH).and the OASIS multinational registry. However contemporary recently completed trials (FRISC-II, TRUCS TACTICS TIMI-18, VINO, RITA-3) have consistently shown benefit using an early invasive strategy on the combined outcome of refractory angina, myocardial infarction, and death, although the mortality as an isolated end point did not change. Current evidence suggests that the use of an invasive approach together with an aggressive anticoagulation and antiplatelet therapy should be the choice.

Key words
Acute coronary syndromes, early invasive strategy, conservative strategy

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