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""The American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology guidelines recommend an early invasive strategy for patients presenting with non�CST-segment elevation acute coronary syndrome (NSTE-ACS) without life-threatening symptoms but with high-risk features (1?and?2). An early invasive strategy consists of coronary angiography within 24 to 72 h, with subsequent revascularization when indicated. This recommendation is supported by meta-analyses showing evidence of an early hazard balanced by a late benefit, resulting in a significant reduction in death or myocardial infarction Sitaxentan (MI) (3, 4?and?5). The ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial compared an early invasive with a selective invasive strategy in patients with NSTE-ACS and positive troponin T (6). The ICTUS trial showed no benefit of the early invasive strategy for the composite of death, MI, or rehospitalization for anginal symptoms at 1- and 3-year follow-up (6?and?7). For patients stabilized on medical treatment, a Class IIb recommendation was included in the ACC/AHA guidelines for a selective invasive strategy (1). The 5-year results of Selleck Tenofovir the RITA-3 (Randomized Intervention Trial of unstable Angina 3) and FRISC II (Fast Revascularization in InStability in Coronary artery disease II) trials both emphasized the importance of long-term outcomes, showing differences in short-term and long-term mortality (8?and?9). Moreover, these studies showed a beneficial effect of the invasive strategy, most apparent in high-risk patients. To investigate the occurrence of late clinical events, we present the 5-year clinical outcomes of death and MI of the ICTUS trial, Nutlin-3a purchase with additional subgroup analyses by categories of baseline risk. The design of the Dutch multicenter ICTUS trial has been published previously (6). In short, 1,200 patients with NSTE-ACS and elevated cardiac troponin T were randomized to an early invasive or a selective invasive strategy. Patients (age 18 to 80 years) were eligible if the following criteria were met: symptoms of ischemia that were increasing or occurring at rest, with the last episode occurring