Early Catheterization for Non–ST-Segment Elevation MI: How High Is the Bar?

Clinical trial findings and guidelines support an early invasive strategy for high-risk patients with non–ST-segment-elevation MI, but prior studies have shown that many high-risk NSTEMI patients do not undergo early angiography. To explore why this occurs, investigators studied data from the Canadian Acute Coronary Syndromes Registry II on 2136 patients presenting with NSTEMI between October 1, 2002, and December 31, 2003. In this registry, when a patient was not referred for in-hospital angiography, the physician responsible for the decision was asked why.

Compared with patients who did not undergo angiography, those who did had lower in-hospital mortality (0.8% vs. 3.7%), 1-year mortality (4.0% vs. 10.9%), and 1-year rate of death or rein…