Purpose of review: This review describes available data on the optimal timing of an early invasive strategy in patients with high-risk non-ST-segment elevation acute coronary syndromes, along with challenges with type of studies. We also discuss the implication of timing in the overall management of the non-ST-segment elevation acute coronary syndrome patients.
Recent findings: The issue of timing of the coronary angiography has been addressed mainly with observational analyses. The only, small, randomized clinical trial, the Intracoronary Stenting With Antithrombotic Regimen Cooling-Off, indicated a superiority of an expedited approach compared with a much deferred angiography. A recent observational analysis adopting special statistical methodologies confirmed the finding of the Intracoronary Stenting With Antithrombotic Regimen Cooling-Off trial in patients undergoing an early invasive strategy in the first 48 h of presentation.
Summary: Current evidence is not sufficient to recommend the use of a routine expedite invasive strategy but suggests that it may be a viable approach.