Is an invasive interventional strategy of value in non-ST-elevation acute coronary syndromes?

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Cost-effectiveness can be a helpful indicator of therapeutic value and is an important consideration when determining whether to use an invasive strategy in patients with non-ST-elevation (NSTE) acute coronary syndromes. In an economic analysis using results from RITA 3, Henriksson et al. found that an invasive strategy was not cost-effective in patients with low-risk disease, but was cost-effective for patients with high-risk disease and of equivocal cost-effectiveness in patients with intermediate-risk disease. This finding is consistent with those of other studies, especially FRISC II and TACTICS-TIMI 18, which found an invasive strategy to be cost-effective in patients with biomarker-positive NSTE myocardial infarction. An invasive strategy should, therefore, be considered for treatment of patients with high-risk NSTE myocardial infarction. Although available data are not based on the latest technology, another trial in this area would be difficult to conduct and of questionable ethics.

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