Table 2 Included studies protocol for invasive and conservative strategies during the index hospitalization

FRISC II

[34]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that all invasive procedures be performed within 7 days after starting OMT

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory/recurrent symptoms or severe ischemia at predischarge exercise test

RITA 3

[35]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed as soon as possible, ideally within 72 h after randomization

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: recurrent ischaemic pain at rest or on minimum exertion, with transient or persistent ECG evidence of ischemia or the inability to withdraw intravenous antianginal or antithrombotic treatment without recurrence of ischaemic pain

TACTICS–TIMI 18

[9]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed within 4–48 h after randomization

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: prolonged angina at rest, hemodynamic instability, documented ischemia during predischarge exercise test, moderate to severe stable angina, recurrent UA, or a new MI

ICTUS

[36]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography to be performed within 24–48 h after randomization

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory angina, hemodynamic/rhythmic instability, or clinically significant ischemia on the predischarge exercise test

Italian Elderly ACS

[31]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed within 72 h of admission

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory/recurrent ischemia, myocardial (re)infarction, heart failure of ischemic origin, or malignant ventricular arrhythmias

MOSCA

[30]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed within 72 h of admission

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory/recurrent ischemia, worsening heart failure, or positive predischarge non-invasive stress test

After Eighty

[21, 33]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed within 72 h of admission

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory angina, myocardial (re)infarction, heart failure, or malignant ventricular arrhythmias

80 + study

[29]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* No clear timeframe has been proposed within the study protocol for the invasive coronary angiography

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory angina, hemodynamic instability (including cardiogenic shock), heart failure, or life-threatening arrhythmias

RINCAL

[28]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* No clear timeframe has been proposed within the study protocol for the invasive coronary angiography

OMT alone; patients were permitted to have diagnostic angiography if there was ongoing chest pain with or without dynamic ECG changes and/or further rise in troponin levels

MOSCA-FRAIL

[20, 32]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has mandated that the initial invasive coronary angiography be performed within 72 h of admission

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: refractory/recurrent ischemia

SENIOR-RITA

[26]

Initial management: OMT + invasive coronary angiography^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* The study protocol has recommended that the initial invasive coronary angiography be performed within 3–7 days of randomization

Initial management: OMT ± invasive coronary angiography if indicated^* ± coronary revascularization (PCI/CABG) based on coronary angiography’s findings

* Indications of invasive coronary angiography within the index hospitalization: clinical deterioration that the angiography is deemed to be needed at the discretion of the treating physician