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- International guidelines recommend early invasive strategy (<24hrs) for patients with NSTEMI w/high risk factors defined by a GRACE score >140
- A recent meta-analysis based on 7 RCTs & 4 observational studies demonstrated an inconclusive survival benefit with an early invasive strategy
- Heterogeneity across multiple studies including timing of intervention, definition of MI, patients' risk profiles, major bleeding, and sample size make the interpretation of survival results difficult
- Based on the most recent data the optimal timing of intervention remains unclear and a more definite RCT is warranted to guide clinical practice
References
Navarese E, et al. Optimal Timing of Coronary Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndromes. Ann Intern Med. 2013;158:261-270.