ABSTRACT
INTRODUCTION Multiple randomized clinical trials have examined whether aggressive approaches to the treatment of acute myocardial infarction (MI)—using invasive and costly procedures such as angiography in all patients and revascularization in most patients-added a benefit compared with more conservative approaches that use cardiac procedures more selectively [1-9]. The results of these studies have called into question whether there is any clinical advantage to an aggressive approach. Thus, the clinical practice guidelines of authoritative bodies such as the American Heart Association and American College of Cardiology have recommended the use of angiography only in patients who develop complications and show evidence of inducible ischemia after acute MI [10,11]. Despite the results of these studies and the publication of practice guidelines for the use of angiography and revascularization after acute MI, wide international and regional variations in the treatment of acute MI persist.
