Therapy

For patients with 

• new ST depression of at least 0.5 mm, transient (< 20 min) ST elevation of at least 1 mm, or T wave inversion of at least 3 mm in 2 or more leads
• elevated cardiac markers
• history of coronary disease from catheterisation, revascularisation or myocardial infarction

arrange for urgent angiography and revascularisation if required as soon as possible ^a

Why?

• Patients with an acute coronary syndrome, who undergo angiography within 5 days with angioplasty as required (using stenting and abcixmab) compared with a conservative strategy (glycoprotein IIb/IIIa inhibitors and revascularisation only after a positive stress testing or refractory angina), are less likely to die, have a myocardial infarction, or be readmitted to hospital. ^a
• Patients on tirofiban who undergo angiography within 2 days with angioplasty and stenting as required compared with a conservative strategy are less likely to die, have a myocardial infarction or be readmitted with an acute coronary syndrome. ^a
• The early revascularisation strategy leads to more coronary angiographies, angioplasties, and CABGs. ^a

An early invasive strategy using glycoprotein IIb/IIIa inhibitors reduces death, myocardial infarction and hosp

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute coronary syndrome on tirofiban a	angiography within 48 hours and revascularisation if required	angiography and revascularisation if failure of medical therapy	myocardial infarction at 6 months	6.9%	31% (3% to 51%)	47 (25 to 590)
			coronary angioplasty at 6 months	29%	45% (29% to 63%)	8 (6 to 11)
			CABG at 6 months	16%	36% (14% to 61%)	17 (11 to 41)
acute coronary syndrome a	angiography within 5 days and revascularisation if required using abciximab and stenting or CABG	angiography and revascularisation if failure of medical therapy	readmission to hospital at 12 months	57%	35% (29% to 41%)	5 (4 to 6)
			death at 12 months	3.9%	43% (10% to 64%)	33 (19 to 160)
unstable angina or non-Q wave MI a	angioplasty within 48 hours followed by revascularisation if required	angioplasty if failure of medical therapy	use of 1 or fewer antianginal drugs at 6 weeks	46%	15% (4% to 28%)	14 (8 to 53)