[Invasive revascularization strategy in non-ST-segment acute coronary syndromes. The debate continues]

Revascularization strategy in the setting of non-ST-segment acute coronary syndromes remains a controversy. Evidence obtained from clinical trials, generally performed in selected patients, reveals heterogeneous and insufficient results when a routine invasive revascularization strategy and a conservative one are compared. The conflicting results among trials are due to differences in: a) baseline characteristics; b) methodology and protocols applied and; c) objectives and outcomes definitions. Although present guidelines recommend that a routine invasive strategy should be used in high risk non-ST-segment elevation acute coronary syndromes, there is no consistent evidence that supports this approach. In order to reach definitive conclusions, further randomized studies should: a) expand inclusion criteria to highest risk populations and; b) standardize the methodology, objectives and outcome definitions.