[Acute coronary syndromes without ST segment elevation. Why should we take an interventionist approach?].

The incidence of unstable angina and non-Q-wave myocardial infarction has increased dramatically. Risk of death and infarction is greatest in the first 6-8 weeks after admission. Risk stratification should be performed in patients with acute coronary syndromes at the earliest opportunity. The VANQWISH trial and TIMI-III B suggested that most patients do not benefit from routine, early invasive management. In the FRISC II trial, the rates of death/myocardial infarction at 6 months were 9.4% in patients treated with an early invasive strategy vs 12.1% with a more conservative approach. The previously reported superiority of the invasive strategy was also confirmed by the TACTICS-TIMI 18. The trial's primary composite end point at 6 months was significantly reduced in the invasive group: 15.9% vs 19.4% of the conservative group. The early invasive strategy was more beneficial the higher the patient's risk. We do not know whether we have reached the limits in terms of improving outcome with available strategies. What we do know is that all patients discharged following an acute coronary syndromes need to be treated aggressively in order to neutralize vulnerable atherosclerotic plaques and to manage cardiovascular risk factors.