Routine invasive strategies compared with conservative strategies do not lower the all-cause mortality in patients with non-ST elevation myocardial infarction and unstable angina.

Commentary on: Fanning JP, Nyong J, Scott IA, et al . Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era. Cochrane Database Syst Rev 2016:CD004815. Urgent coronary artery revascularisation with stents following an acute ST elevation myocardial infarction (MI) reduces mortality and the incidence of reinfarction. Current guidelines recommend the use of routine invasive strategies (RINVS) in patients with an acute non-ST elevation (NSTE) MI and in those with unstable angina (UA) with high-risk features. However, these guidelines are not necessarily evidence-based, and concern remains whether the RINVS is indeed superior to a selective invasive strategy (SINVS). This review and meta-analysis compares the benefits and harms associated with RINVS, in the stent era, with or without the use of glycoprotein (GP) IIb/IIIa receptor antagonists, with SINVS in patients with …