According to the recent guidelines from the European Society of Cardiology,1 an invasive strategy should be performed within the first 24 hours from diagnosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at high risk; and a very early invasive strategy (<2 hours) deserves only to those patients at very high risk. The question of the optimal timing of the invasive procedure is however still a matter of debate. In this context, the absence of P2Y12 inhibitor (P2Y12i) pretreatment may impact the decision. Indeed, in the absence of P2Y12i pretreatment, recurrent ischaemic events may occur more frequently pending the coronary revascularisation and may subsequently have a deleterious effect on patient outcome. In recent guidelines,1 routine P2Y12i pretreatment is not recommended (class III-A) if early invasive management is planned (<24 hours), but pretreatment may be considered if early invasive strategy is not possible and the patient is not at high risk of bleeding (class IIb-C). In the past, several trials have tried to answer this critical question. In a meta-analysis published in 2016, it was observed that a very early strategy is associated with a reduction in recurrent ischaemia or refractory angina and a shorter in-hospital stay but has no significant impact on mortality.2 The year after, another meta-analysis confirmed the lack of benefit of a very early strategy on all-cause mortality, but …

中文翻译：

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非ST段抬高型心肌梗死患者的极早期侵入性治疗策略：我们应该采取吗？

根据欧洲心脏病学会最近的指南1，对于高危非 ST 段抬高型急性冠状动脉综合征 (NSTE-ACS) 患者，应在诊断后 24 小时内实施侵入性策略；非常早期的侵入性策略（<2 小时）只适合那些风险极高的患者。然而，侵入性手术的最佳时机问题仍然存在争议。在这种情况下，缺乏 P2Y12 抑制剂 (P2Y12i) 预处理可能会影响决策。事实上，在缺乏 P2Y12i 预处理的情况下，在冠状动脉血运重建期间，复发性缺血事件可能会更频繁地发生，并可能随后对患者的预后产生有害影响。在最近的指南中，1 如果计划进行早期侵入性治疗（<24 小时），则不建议常规 P2Y12i 预处理（III-A 级），但如果早期侵入性策略不可能且患者不存在高风险，则可以考虑预处理。出血（IIb-C 级）。过去，多项试验试图回答这个关键问题。2016 年发表的一项荟萃​​分析发现，非常早期的策略与减少复发性缺血或难治性心绞痛以及缩短住院时间有关，但对死亡率没有显着影响。2 一年后，另一项荟萃分析-分析证实，非常早期的策略对全因死亡率缺乏益处，但是……