Issues in cardiac intervention for UA/NSTEMI

The ACC/AHA and the ESC have recently developed new treatment guidelines for the management of unstable angina and non-ST-segment elevation myocardial infarction, and both documents make recommendations with regard to interventional management. At the 4th Annual Experts' Meeting of the International Cardiology Forum, workshops were held to discuss the evidence supporting these recommendations, the applicability of the guidelines to clinical practice in different countries and institutional settings, and areas where more research is required. Although both sets of guidelines were generally well received, workshop participants disagreed on a number of issues. Opinion was divided as to the specific risk-factors that should mandate early catheterization, and the optimal timing of intervention following the initial presentation. Further clinical trials addressing these questions are needed. However, in many parts of the world, interventional strategies are influenced by external constraints, including shortage of facilities or limitations on length of hospital stay, which may limit the applicability of clinical evidence.