Acute coronary syndromes: selective vs early invasive strategies

Recommendations in the 2007 update of the American College of Cardiology/American Heart Association guidelines for patients with non-ST-elevation myocardial infarction (NSTEMI) provide considerable latitude regarding treatment choices and care pathways. Nevertheless, as accumulating evidence leads to increased recommendations for early invasive strategies, more patients are likely to receive care that falls short of recommendations. While tailoring pharmacotherapy to optimize the risk/benefit ratio for individual patients remains essential, it becomes increasingly important that care paradigms be prospectively defined. To facilitate this goal, we examined key differences between the 2002 and 2007 guidelines and explored data underlying changed recommendations for periprocedural pharmacotherapy.