An early invasive strategy reduced death, myocardial infarction, and hospital readmissions at 2 years in unstable CAD.

P a t i e n t s 2457 patients (median age 65 y, 70% men) with symptoms of unstable CAD, most recent episode of chest pain ≤ 48 hours before the start of dalteparin or regular heparin, and signs of myocardial ischemia (ST-segment depression, T-wave inversion, or raised biochemical myocardial markers). Exclusion criteria included thrombolysis in the previous 24 hours, angioplasty within the past 6 months, previous open heart surgery, and age > 75 years. All patients received aspirin and open-label dalteparin for ≥ 5 days. Follow-up was 99%. I n t e r v e n t i o n Patients were allocated to invasive therapy (coronary angiography, revascularization within 7 d of hospital admission, percutaneous coronary intervention for 1 or 2 lesions, and coronary bypass graft surgery for 3-vessel or left main CAD) {n = 1222}† or noninvasive therapy (coronary angiography for refractory or recurrent symptoms despite maximal medical treatment or severe ischemia on a predischarge symptom-limited exercise test) {n = 1235}†.