The early, invasive treatment of acute coronary syndromes that is recommended by the American College of Cardiology, American Heart Association, and European Society of Cardiology was no better than a more conservative approach in a large, randomized clinical trial comparing the two strategies. The trial was undertaken becuase it was unclear if early revascularization lowered mortality in high-risk ACS patients, compared with early, intensive medical therapy followed by revascularization only in selected patients.
In the trial, 604 patients at 42 hospitals in the Netherlands were randomly assigned to undergo early angiography with percutaneous coronary intervention or coronary artery bypass graft surgery when appropriate, and 596 were assigned to medical management and proceeded to revascularization only if medical therapy failed.
Mortality at 1 year was identical in the two groups (2.5%), and freedom from angina was nearly identical. In contrast, the risk of MI was 5% higher in those who had early, invasive treatment, and most of the MIs were procedure related, reported Robbert J. de Winter, M.D., Ph.D., of the Academisch Medisch Centrum, Amsterdam, and his associates (N. Engl. J. Med. 2005;353:1095–104).