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Is an early invasive approach superior to a conservative strategy in patients with acute coronary syndrome?

Department of Cardiology, Stepping Hill Hospital, Stockport, Manchester, UK

^* Corresponding author. Address: Department of Cardiothoracic Surgery, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK. Tel.: +44-780-154-8122; fax: +44-161-276-8538
joeldunning{at}doctors.org.uk

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether an early invasive approach (involving early coronary angiography followed by revascularisation if suitable) is superior to a conservative approach (with revascularisation only in patients with failed medical therapy) in patients with acute coronary syndrome. Altogether 282 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that in patients diagnosed with acute coronary syndrome, an early invasive approach is clearly superior to a conservative approach.

Key Words: Evidence-based medicine; Thoracic surgery; Acute coronary syndrome; Review