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Acute coronary syndrome (ACS) is predominantly caused by acute luminal narrowing due to sudden thrombus formation or plaque haemorrhage imposed on an atherosclerotic plaque [1]. A luminal thrombus forms as a direct consequence of plaque rupture or erosion. The initial electrocardiogram can be used to differentiate ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE-ACS). Patients with STEMI are characterised by a complete and persistent occlusion of a large epicardial coronary artery and are best managed with immediate revascularisation by primary percutaneous coronary intervention [2]. Primary percutaneous coronary intervention (PCI) for STEMI is associated with a reduction in mortality compared with other reperfusion strategies [3]. In NSTE-ACS, typically an angiographically significant stenosis is observedwhile epicardial flow is maintained. Therefore, multiple treatment strategies with regard to coronary angiography and revascularisation have been investigated over the years. The first step is whether to proceed with a routine invasive or selective invasive strategy. A routine invasive strategy consists of angiography within 24 to 72 hours, while a selective invasive strategy consists of coronary angiography only in cases of refractory angina and/or inducible ischaemia by non-invasive stress testing. The Dutch multicentre ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial

Treatment strategies and outcomes in patients with non-ST-elevation acute coronary syndrome in the Netherlands