Catheterization laboratories open 24 hours a day, every day: does stable non-ST-elevation acute coronary syndrome need the offer?

NonST-elevation acute coronary syndrome (NSTE-ACS) represents the majority of ACS. Despite the fact that we pay most attention to ST-elevation-ACS, NSTE-ACS is where logistically the action is, as these patients account for 3 out of 4 hospital ACS discharges. Recent studies have helped to clarify that a strategy of routine catheterization is superior to a conservative strategy of catheterization only if the patient develops spontaneous or stress-induced ischaemia. Routine angiography and revascularization after NSTE-ACS reduces mortality by 25%, myocardial infarction by 18%, and re-hospitalization for unstable angina by 31% at mid-term follow-up. However, it is still controversial, for initially stabilized patients, whether the catheterization and percutaneous coronary intervention (PCI) need to be done early (i.e. within 24 h) or whether they could be delayed ≥1 day while the patient receives medical therapy and logistic attention. Thus, should we open our laboratories 24 h a day, every day, to catheterize NSTE-ACS patients early, even within the first few hours of hospital admission, analogous to the standard of primary PCI?