Heart 2009;95:1815-1817
Editorials
Delays in angiography may cost lives
London Chest Hospital, Bethnal Green, London
Correspondence to Professor M T Rothman, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, UK; rothcons@dircon.co.uk
| The first 150 words of the full text of this article appear below. |
Non-ST-elevation acute coronary syndromes (NSTEACS) represent a growing challenge to cardiologists. While ST-elevation infarction (STEMI) has been attracting the focus of acute cardiovascular healthcare systems owing to the proliferation of 24-hour regional primary percutaneous coronary interventions (PCI) services, NSTEACS management has lagged behind.
More numerous,1 and with a higher cumulative mortality than STEMI,2 this spectrum of conditions is threatening to be the "elephant in the room" of acute coronary syndromes.
Access to diagnostic coronary angiography and, if necessary, revascularisation within 72 hours of presentation is a class 1A indication in North American and European guidelines for those with high or intermediate risk features for poor clinical outcome. This strong recommendation is based on contemporary randomised trials, including meta-analyses3 4 comparing a systematic invasive strategy against a default conservative medical strategy with intervention only in the event of refractory ischaemia. Cost-effectiveness analyses also indicate that targeting those at highest risk is of
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