- Question
- In patients with moderate-risk unstable coronary artery disease, is an early interventional strategy (angiography followed by revascularisation) better than a conservative strategy?
- Design
- Randomised multicentre trial, open-label with respect to the assigned strategy, of 1810 patients with non-ST-elevation acute coronary syndromes (mean age 62 years, 38% women), analysed by intention to treat. Both groups received enoxaparin as the antithrombin agent.
- Population
- Patients with non-ST-elevation acute coronary syndromes (unstable angina or non-ST-elevation myocardial infarction) at moderate risk of death.
- Intervention
- Early interventional strategy: angiography followed by revascularisation where appropriate, plus enoxaparin.
- Control
- Conservative strategy: ischaemia-driven or symptom-driven angiography, plus enoxaparin.
- Primary outcome
- Two co-primary endpoints: death, non-fatal myocardial infarction or refractory angina at 4 months; and death or non-fatal myocardial infarction at 1 year.
- Results
- At 4 months, the composite occurred in 86 patients (9.6%) in the interventional group versus 133 (14.5%) in the conservative group (risk ratio 0.66; 95% CI 0.51-0.85; p=0.001), a difference mainly due to a halving of refractory angina. At 1 year, death or myocardial infarction was similar between groups (7.6% vs 8.3%; risk ratio 0.91; 95% CI 0.67-1.25; p=0.58).
- Conclusion
- In unstable coronary artery disease, an interventional strategy was preferable to a conservative one, mainly because of less refractory or severe angina, without increased risk of death or myocardial infarction.
- Why it matters
- It supported an early invasive strategy in moderate-risk non-ST-elevation acute coronary syndromes, improving symptoms and reducing antianginal medication use without increasing hard events.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026