Early invasive treatment strategies in patients with non-ST-elevation acute coronary syndromes: which patients should be treated invasively?

Early invasive strategy is a major therapeutic alternative in the treatment of patients with non-ST segment elevation acute coronary syndromes. In the recent randomised trials, there is a tendency supporting invasive strategy during the very early period of the disease and it is recommended routinely in almost all patients. Despite this strategy has a questionable effect on mortality per se, there is a re- markable benefits on reinfarction and rehospitalization rates especially in high risk subset of the patients. In addition to these medical benefits, an economical advantage of the invasive strategy is a reality by decreasing the hospital stay and reintervention incidence. Before intervention, optimal upstream medical treatment, selection of high risk patients and the lesions in which the intervention success expectation is low, is crucial for increasing the success of this strategy.