Role and timing of coronary intervention in non-ST-elevation myocardial infarction

Non-ST-elevation myocardial infarction (NSTEMI) has become the most common presentation of acute myocardial infarction. Its treatment is challenging and often less straightforward compared with ST-elevation myocardial infarction (STEMI). First, clinicians must decide whether an initial invasive or an initial conservative treatment is appropriate for their NSTEMI patient. If an invasive strategy is chosen, subsequent decisions on the optimal timing of coronary angiography and possible intervention have to be made. Both aggressive and conservative strategies have their own potential risks and benefits. Aggressive strategies may result in more procedural complications, which is especially unwanted in patients otherwise at low risk of events. By contrast, conservative strategies may be harmful in high-risk patients who benefit most from early reperfusion therapy. We aim to discuss the evidence base of this decision process where risk stratification is of paramount importance with the goal of obtaining the optimal outcome for the individual patient.