Early invasive strategy in patients with non-ST segment elevation acute coronary syndrome delays death or MI by 18 months.

Commentary on: Wallentin L, Lindhagen L, Arnstrom E, et al . Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study. Lancet 2016;388:1903–11. The role of coronary arteriography in patients with non-ST segment elevation acute coronary syndrome is controversial. Many cardiologists advocate a ‘routine invasive strategy’, which comprises coronary arteriography within a few days of presentation and myocardial revascularisation determined by the angiographic findings, but this exposes patients to procedural risks and incurs significant costs. Other clinicians favour a ‘selective invasive strategy’, with coronary arteriography reserved for patients with recurrent myocardial ischaemia. Randomised trials of these treatment strategies suggest that a routine invasive strategy reduces the risk of recurrent ischaemia and death or recurrent myocardial infarction over 5 years.1 In the RITA-3 trial, a routine invasive strategy was also associated with lower cardiovascular …