Immediate percutaneous coronary intervention in NSTE-ACS: the sun is not hurried by early risers

Excerpt

Primary percutaneous coronary intervention (PCI) has unequivocally proven to be the optimal reperfusion treatment strategy in patients with ST-segment elevation myocardial infarction, whereby timing is simply an issue of the sooner the better. In recent years, it has additionally become apparent that an early invasive approach is also beneficial in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The definition of early in this subset of patients is, however, ambiguous. Based on risk stratification parameters, high-risk patients (i.e. GRACE score > 140) are preferably subjected to invasive diagnosis and potential PCI within 24 h whereas in low-intermediate risk patients, urgency of coronary angiography is of lesser importance and advocated to occur within a timeframe of 72 h after the initial diagnosis. These guidelines dictate the timeframe in which the invasive approach should be employed at the latest but do not indicate whether an immediate treatment may yield an even better outcome [1]. …