© 2003 by BMJ Publishing Group & British Cardiac Society
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ISCHAEMIC HEART DISEASE
There is no need to "cool-off" the ACS before intervention 
Once the benefits of percutaneous coronary intervention (PCI) in acute coronary syndromes had been accepted, the next decision was on whether to do it very early, or after a cooling-off period of 2–3 days. This period would allow some settling of inflammatory and thrombotic tendency with appropriate medical treatment, making PCI safer. Not so it seems. Patients were randomly allocated to antithrombotic pretreatment for 3–5 days or to early intervention after pretreatment for less than six hours. In both groups, antithrombotic pretreatment consisted of intravenous unfractionated heparin, aspirin, clopidogrel (600 mg loading dose followed by 75 mg twice daily dose), and intravenous tirofiban. The primary end point was reached in 11.6% (three deaths, 21 infarctions) of the group receiving prolonged antithrombotic pretreatment and in 5.9% (no deaths, 12 infarctions) of the group receiving early intervention (relative risk (RR) 1.96, 95%
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