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MI = myocardial infarction.

*Six (0.5%) of these events occurred before the randomized revascularisation procedure. Adapted from Wallentin et al. Outcomes at one year after an invasive compared with a non-invasive strategy in unstable coronary artery disease. The FRISC II invasive randomized trial. FRISC II Investigators Fast Revascularization during Instability in Coronary artery disease. Lancet 2000;356-16 (ref. 38)

MI = myocardial infarction.

*Six (0.5%) of these events occurred before the randomized revascularisation procedure. Adapted from Wallentin et al. Outcomes at one year after an invasive compared with a non-invasive strategy in unstable coronary artery disease. The FRISC II invasive randomized trial. FRISC II Investigators Fast Revascularization during Instability in Coronary artery disease. Lancet 2000;356-16 (ref. 38)

domized to an invasive approach (coronary angiography within 2-7 d) or to a conservative strategy. In addition, patients were randomized to dalteparin or placebo for 3 mo. After 6 mo, 78% of patients in the invasive arm had undergone revascularization vs 43% in the conservative arm. Of those who underwent percutaneous revascularization, 60% were stented. At 1 yr (Table 4), patients randomized to the invasive arm had lower rates of death (2.2 vs 3.9%, risk ratio 0.57 [95% CI: 0.36-0.90], p = 0.016), MI (8.6 vs 11.6%, risk ratio 0.74 [0.59-0.94], p = 0.015), death or MI (10.4 vs 14.1%, risk ratio 0.74 [0.60-0.92], p = 0.005). They also had less hospital readmission (37 vs 57%, risk ratio 0.67 [0.62-0.72]), and target vessel revascularization (7.5 vs 31%, risk ratio 0.24 [0.20-0.30],p < 0.01). In other words, after 1 yr in 100 patients, an invasive strategy saved 1.7 lives, prevented 2.0 nonfatal MIs and 20 readmissions, and provided earlier and better symptom relief at the cost of15 more patients with CABG and 21 more with PTCA.

In summary, based on the FRISC II trial, the investigators concluded that an early invasive approach should be the preferred strategy in most patients with unstable coronary artery disease who have signs of ischemia on electrocardiography or raised biochemical markers of myocardial damage.

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