A 65-year-old man presents with an NSTEMI. Risk stratification using the TIMI score shows 5 out of 7. According to current ACC/AHA guidelines (ESC/ACC 2023 updates), what is the recommended reperfusion strategy?

• A Immediate emergency PCI within 2 hours
• B Early invasive strategy with coronary angiography within 24 hours ✓
• C Conservative (ischaemia-guided) strategy with medical management and stress testing
• D Thrombolysis with alteplase followed by angiography at 3–24 hours

Explanation

A TIMI score ≥3 or high-risk features in NSTEMI warrant an early invasive strategy (angiography within 24 hours) per 2023 ACC/AHA NSTEMI guidelines. An immediate (<2 hours) or very early invasive approach is reserved for haemodynamic instability, refractory ischaemia, cardiogenic shock, or sustained ventricular arrhythmias. Conservative strategy is appropriate only in low-risk patients. Thrombolysis is not indicated in NSTEMI because there is no total occlusion to lyse, and it increases bleeding risk without benefit.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.