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That Is No Longer the Question

Deepak L. Bhatt, MD

JAMA. 2005;293:2935-2937.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Unstable angina and non–ST-segment elevation myocardial infarction, the most frequent manifestations of acute coronary syndromes (ACS), remain common reasons for hospital admission. Despite advances in therapy, ACS are associated with substantial morbidity and mortality. Throughout the 1990s, a debate raged within the cardiology community about whether an "invasive" approach was superior to a "conservative" approach in the initial management of ACS. The invasive approach implied a strategy of routine cardiac catheterization, whereas a conservative approach reserved catheterization for recurrent spontaneous or stress-induced ischemia. However, an invasive strategy does not always result in revascularization, nor does a conservative strategy necessarily imply no catheterization. Nevertheless, in a philosophical sense, these 2 approaches had been viewed as polar opposites.

Some clinicians reasoned that it would be better to treat patients presenting with ACS with medical therapy, including heparin to help dissolve any thrombus and to "passivate the artery."¹ One . . . [Full Text of this Article]

Author Affiliation: Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, Ohio.

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