Abstract
The most common cardiovascular causes of hospital admission in the United States are unstable angina and non—Q-wave myocardial infarction. The efficacy of thrombolytic therapy in patients with these disorders is unclear, and the role of routine early coronary arteriography followed by revascularization is uncertain. The Thrombolysis in Myocardial Ischemia trial randomized 1473 patients with unstable angina or non—Q-wave myocardial infarction in a 2×2 factorial design comparing (1) tissue-type plasminogen activator vs placebo and (2) an early invasive strategy vs an early conservative strategy.<sup>1</sup>The investigators found that thrombolytic therapy was not beneficial and may be harmful. With respect to early coronary arteriography, there was no difference in mortality or recurrent myocardial infarction at 6 weeks. There was, however, a reduction in days of hospitalization and rehospitalization and in the use of antianginal drugs. The current approach to the treatment of patients with acute coronary syndromes is to administer intravenous
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