Early Invasive Management for Non–ST Segment Elevation Acute Coronary Syndrome

Abstract This chapter appraises the TACTICS-TIMI-18 trial, which examines whether an early invasive strategy for non–ST segment elevation acute coronary syndrome reduces the incidence of death, nonfatal myocardial infarction (MI), or rehospitalization compared to a conservative approach. It involves 2200 patients randomized into two groups: one receiving early invasive treatment and the other undergoing conservative management. The chapter shows that the early invasive strategy significantly lowers the risk of the primary composite endpoint by 6 months. It also shows that the early invasive strategy reduces the risk of death, MI, and rehospitalization at 30 days. Finally, the chapter recommends early invasive management for most patients while also considering a conservative approach for low-risk patients or those with extensive comorbidities.