EBQ:Routine vs an Invasive strategy in ACS

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incomplete Journal Club Article
Mehta, Shamir et al. "Routine vs Selective Invasive Strategies in Patients With Acute Coronary Syndromes". JAMA. 2005. 293(23):2908-2917.
PubMed Full text PDF

Clinical Question

Does percutaneous coronary intervention (PCI) for all patients with unstable angina or Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) reduce death and recurrent myocardial infarction in comparison to only performing PCI in patient with recurrent or inducible ischemia


Routine PCI reduced recurrent MI, severe angina, and rehospitalization over a mean follow-up of 17 months when compared to a more conservative selective strategy of PCI.

Major Points

Study Design

Inclusion Criteria

Exclusion Criteria



Primary Outcomes

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion



Cardiovascular question: In the patient with an acute myocardial infarction and cardiogenic shock, which of the following constitutes optimal therapy?

ensure adequate ventilation and oxygenation
treat emergent arrhythmias
administer aspirin if not aspirin allergic
arrange for emergent PCI
All of the above