Early invasive strategy should be performed within 72 hours in high-risk patients with non-ST-elevation myocardial infarction.

Commentary on : Jobs A, Mehta SR, Montalescot G, et al . Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials. Lancet 2017;390:737–46. The mainstay of treatment for patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) is medical therapy, early coronary angiography and revascularisation. A routine invasive strategy has been shown to reduce all-cause death and myocardial infarction  compared with a conservative approach at 5 years.1 Therefore, an early invasive strategy with intent to perform revascularisation is advocated in the 2014 American and European guidelines with a class I recommendation.2 3 While immediate angiography is recommended for extremely high-risk patients (eg, haemodynamic or electrical instability, persistent angina, heart failure or worsening mitral regurgitation), the optimal timing for an invasive approach in patients …