Invasive vs conservative management of non-Q-wave myocardial infarction

In the Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) trial, most patients with non-Q-wave myocardial infarction (MI) fared no better with early invasive management (i.e., diagnostic angiography within 2 to 3 days, followed by revascularization if indicated) than with a more conservative approach (i.e., radionuclide ventriculography and thallium stress testing as initial diagnostic tests). These results should not be construed to diminish the value of early diagnostic angiography, which in patients with non-Q-wave MI provides essential information for determining the need, timing, and method of revascularization. Until more information is available that incorporates contemporary practices and outcomes in patients with non-Q-wave MI, early coronary angiography should remain an acceptable method of risk stratification and should be followed by appropriate medical therapy or revascularization.