scholarly journals EARLY INVASIVE STRATEGY VERSUS INITIAL CONSERVATIVE STRATEGY IN WOMEN WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME: A PROPENSITY SCORE MATCHED NATIONWIDE ANALYSIS

2017 ◽  
Vol 69 (11) ◽  
pp. 978
Author(s):  
Islam Elgendy ◽  
Ahmed Mahmoud ◽  
Hend Mansoor ◽  
Anthony Bavry
2017 ◽  
Vol 37 (3) ◽  
pp. 276-284
Author(s):  
Ildefonso Roldán Torres ◽  
Inmaculada Salvador Mercader ◽  
Claudia Cabadés Rumbeu ◽  
José Luis Díez Gil ◽  
José Ferrando Cervelló ◽  
...  

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318778
Author(s):  
Thomas A Kite ◽  
Andrew Ladwiniec ◽  
J Ranjit Arnold ◽  
Gerry P McCann ◽  
Alastair J Moss

Non-ST-elevation acute coronary syndrome (NSTE-ACS) comprises a broad spectrum of disease ranging from unstable angina to myocardial infarction. International guidelines recommend a routine invasive strategy for managing patients with NSTE-ACS at high to very high-risk, supported by evidence of improved composite ischaemic outcomes as compared with a selective invasive strategy. However, accurate diagnosis of NSTE-ACS in the acute setting is challenging due to the spectrum of non-coronary disease that can manifest with similar symptoms. Heterogeneous clinical presentations and limited uptake of risk prediction tools can confound physician decision-making regarding the use and timing of invasive coronary angiography (ICA). Large proportions of patients with suspected NSTE-ACS do not require revascularisation but may unnecessarily undergo ICA with its attendant risks and associated costs. Advances in coronary CT angiography and cardiac MRI have prompted evaluation of whether non-invasive strategies may improve patient selection, or whether tailored approaches are better suited to specific subgroups. Future directions include (1) better understanding of risk stratification as a guide to investigation and therapy in suspected NSTE-ACS, (2) randomised clinical trials of non-invasive imaging versus standard of care approaches prior to ICA and (3) defining the optimal timing of very early ICA in high-risk NSTE-ACS.


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