A 58-year-old woman with NSTEMI undergoes coronary angiography showing 70% stenosis of the left anterior descending artery with TIMI-2 flow. Her GRACE score is 145. Troponin-I is 4.2 ng/mL. According to current guidelines, what is the optimal invasive strategy timing?
- A Immediate (<2 hours) invasive strategy
- B Delayed (25–72 hours) invasive strategy
- C Early (<24 hours) invasive strategy ✓
- D Conservative (non-invasive) management
Correct answer: C. Early (<24 hours) invasive strategy
Explanation
A GRACE score >140 in NSTEMI is a high-risk feature mandating an early invasive strategy within 24 hours. Immediate (<2 hours) is reserved for very high-risk patients (hemodynamic instability, cardiogenic shock, refractory chest pain, or life-threatening arrhythmias). A GRACE score of 145 with elevated troponin meets the threshold for early but not necessarily immediate PCI. Conservative management is appropriate only for low-risk patients without high-risk features.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.