Which landmark trial demonstrated that routine early invasive strategy (within 24 hours) was superior to selective invasive strategy in high-risk NSTEMI patients, leading to current NSTEMI guidelines recommending early angiography?
- A COURAGE trial
- B TIMACS trial ✓
- C ISCHEMIA trial
- D GUSTO trial
Correct answer: B. TIMACS trial
Explanation
The TIMACS (Timing of Intervention in Patients with Acute Coronary Syndromes) trial showed that early invasive strategy (within 24 hours) reduced the composite endpoint of death, MI, and stroke at 6 months compared to delayed strategy in high-risk NSTEMI patients (GRACE score >140). COURAGE showed PCI vs. medical therapy in stable angina. ISCHEMIA addressed stable ischaemic heart disease. GUSTO evaluated thrombolytics in STEMI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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