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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

New aspects in the treatment of acute coronary syndromes without ST-elevation: ICTUS and ISAR-COOL in perspective

Franz-Josef Neumann1,*, Adnan Kastrati2 and Guido Schwarzer3

1 Herz-Zentrum Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
2 Deutsches Herzzentrum München, Technische Universität, München, Germany
3 Institut für Medizinische Biometrie und Medizinische Informatik, Albert-Ludwigs-Universität, Freiburg, Germany

* Corresponding author. Tel: +49 7633 402 8200; fax: +49 7633 402 8204. E-mail address: franz-josef.neumann{at}herzzentrum.de

For treatment of patients with high-risk acute coronary syndromes, current guidelines recommend early coronary angiography and coronary revascularization, when feasible, irrespective of the primary success of medical treatment. Moreover, the results of a randomized trial (ISAR-COOL) suggested performing revascularization as early as possible. The concept of systematic coronary angiography and revascularization in high-risk acute coronary syndromes has been challenged recently by another randomized study (ICTUS) demonstrating an excess of myocardial infarction during 1-year follow-up with a routine-invasive strategy when compared with a selectively invasive strategy. This review intends to put the new trial results in perspective with evidence from previous studies.

Key Words: Acute coronary syndromes • Percutaneous catheter intervention • Guidelines • Treatment strategies • Timing • Meta-analysis


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