It's never too early! Evidence for rushing your acute coronary patients to the cath lab

Abstract

This editorial refers to ‘Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes’[†][1], by D.G. Katritsis et al. , on page 32 Imagine you have chest pain … A crushing discomfort that has begun at rest, irradiates to your left shoulder, and waxes and wanes over the course of several minutes. You cannot believe it is really an acute coronary syndrome (ACS), as you exercise regularly, are reasonably fit, and try to control your atherosclerotic risk factors as best you can! Still, you call 112 and rush to the Emergency Room for a quick triage. There, a non-ST-elevation ACS is indeed proposed as working diagnosis, but your colleagues face a difficult decision: ‘to cath or not to cath?’ And an even more difficult one, ‘when should we cath?’ As invasive cardiologists and coronary care unit specialists, we would not tolerate much delay. We would trust our own and our colleagues' invasive skills, and would surely prefer a quick rule in/rule out test such as coronary angiography, rather than a painful and passive wait-and-see approach. Yet, do we have evidence in support of such a rushed strategy? Luckily, this issue provides a comprehensive and high-quality systematic review by Katritsis et al. 1 comparing early invasive management against delayed invasive management in patients with non-ST-elevation ACS. As time is crucial in such a comparison, early means a median time from randomization (or admission) to coronary angiography ranging from 1.2 to 14 h, whereas late stands for 20.8–86 h delay … [1]: #fn-2