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Editorials represent the opinions EDITORIALS of the authors and JAMA and not those of the American Medical Association. That Is No Longer the Question subsequent myocardial infarction, severe angina, and rehos- Deepak L. Bhatt, MD pitalization. There was a trend toward mortality reduction during the follow-up period with an invasive approach, NSTABLE ANGINA AND NON–ST-SEGMENT ELEVA- although an early mortality hazard was noted. The benefits tion myocardial infarction, the most frequent of the invasive strategy appear to be particularly marked among manifestations of acute coronary syndromes patients with elevated levels of biomarkers such as troponin. U(ACS), remain common reasons for hospital ad- As with any meaningful clinical investigation, this analy- mission. Despite advances in therapy, ACS are associated sis spawns additional questions. The finding of an early mor- with substantial morbidity and mortality. Throughout the tality hazard with a routine invasive strategy deserves care- 1990s, a debate raged within the cardiology community about ful study, and approaches to mitigate or abolish this early whether an “invasive” approach was superior to a “conser- risk must be explored. A substantial portion of this early vative” approach in the initial management of ACS. The in- mortality risk is most likely due to
JAMA – American Medical Association
Published: Jun 15, 2005
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