Commentary on Clinical Guidelines and Practice: In Search of the Truth by Dean J. Kereiakes and Elliott M. Antman Review Article

In the field of non–ST-segment acute coronary syndromes, the evidence from recent randomized controlled trials favors early invasive management in high-risk patients. However, data from the recent ICTUS (Invasive versus Conservative Treatment in Unstable Coronary Syndromes) trial and from several large “real-world” registries suggest that the benefit may be modest. In contrast, in the field of ST-segment elevation myocardial infarction, mechanical reperfusion with primary percutaneous coronary intervention (PCI) has been shown to be superior to thrombolytic therapy. Therefore, efforts should be directed to the organization of regional networks aimed at prehospital triage and swift transfer of patients to dedicated PCI centers with experienced staff and high-volume interventional operators.