Two approaches to the use of cardiac catheterization and revascularization in UA/NSTEMI include:
An<unk><unk>  strategy, involving routine early cardiac catheterization and revascularization with percutaneous coronary intervention (PCI), or coronary bypass grafting (CABG).<unk>  strategy can be early (< 24 hours)<unk>  strategy can be delayed (> 24 hours)<unk>  medical management with catheterization and revascularization is used only for recurrent ischemia either at rest, or on a noninvasive stress test.<unk>  strategy can be early (< 24 hours)<unk>  strategy can be delayed (> 24 hours)
Clinical practice guidelines and systematic reviews state:
“Early angiography and coronary intervention have been more effective in reducing ischemic complications than delayed interventions, particularly in patients at high risk (defined by a GRACE score >140)”.
“An early<unk>  strategy within 24 h is recommended for high-risk patients with positive cardiac biomarkers, dynamic ST-T changes, or a GRACE risk score more than 140 points” (28778541).
“Subgroup analysis demonstrated a significant reduction in recurrent MI amongst patients treated <24 hours”.
“Patients with unstable features, such as hemodynamic instability or major arrhythmias, should still receive intervention within two hours as per the European Society of Cardiology (ESC) guidelines”.
For the efficacy of early,<unk>  late intervention, the number needed to treat (NNT) are:
Major cardiovascular events (MACE) such as death, myocardial infarction, or stroke:
NNT for early vs late intervention to avoid MACE in GRACE score 0-140 = -111 (Not clinically nor statistically significant)
NNT for early vs late intervention to avoid MACE in GRACE score ≥141 = 14.1 & P-Value = 0.01 (Clinically and statistically significant)
Recurrent ischemia:
NNT for early vs late intervention to avoid recurrent ischemia = 28.4 & P-Value = 0.004 (Clinically and statistically significant)
NNT for early vs late intervention to avoid MACE in GRACE score 0-140 = -111 (Not clinically nor statistically significant)
NNT for early vs late intervention to avoid MACE in GRACE score ≥141 = 14.1 & P-Value = 0.01 (Clinically and statistically significant)
NNT for early vs late intervention to avoid recurrent ischemia = 28.4 & P-Value = 0.004 (Clinically and statistically significant)
Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for patient education
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines antioxidant vitamins and folic acid
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines depression
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines nonsteroidal anti-inflammatory drugs
Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for nitroglycerin