Investigations

• prolonged angina with an ischaemic ECG 
• abnormal stress testing
• moderate to severe angina after hospital discharge despite maximal anti-ischaemic therapy

Perform angiography followed by revascularisation as soon as possible. ^b  

Why?

• Patients who live in countries that offer angiography and revascularisation within 7 days of admission compared with delayed investigation are less likely to have refractory angina, but more likely to have a stroke or major bleeding. There is no clear effect on mortality or myocardial infarction. ^b

Early angiography and revascularisation reduces refractory angina and hospital admissions

Patient b	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
unstable angina	early angiography and revascularisation	delayed angiography and revascularisation	refractory angina or readmission for unstable angina at 6 months	20%	0.64 (0.56 to 0.73)	16 (13 to 22)
unstable angina	early angiography and revascularisation	delayed angiography and revascularisation	stroke at 6 months	1.2%	1.6 (1.1 to 2.4)	-140 (-840 to -61)
unstable angina	early angiography and revascularisation	delayed angiography and revascularisation	major bleeding at 6 months	1.1%	1.8 (1.2 to 2.7)	-120 (-460 to -55)

Note:

• The shape of lesions or presence of thrombus on angiography does not clearly predict death, myocardial infarction or need for revascularisation. ^c