A 55-year-old man with NSTEMI has a GRACE score of 145 (high risk). He is on aspirin, ticagrelor, heparin, and statin. Echocardiography shows EF of 35%. According to current ACC/AHA guidelines, what is the optimal timing for coronary angiography?
- A Immediate (within 2 hours) — same as STEMI protocol
- B Selective invasive strategy only if recurrent ischemia occurs
- C Early invasive strategy within 24 hours ✓
- D Elective angiography after 1–2 weeks of medical therapy
Correct answer: C. Early invasive strategy within 24 hours
Explanation
In high-risk NSTEMI (GRACE >140, hemodynamic instability, EF <40%, high troponin rise), ACC/AHA 2021 guidelines recommend an early invasive strategy with coronary angiography within 24 hours. The immediate strategy (within 2 hours) is reserved for very high-risk features such as cardiogenic shock, refractory chest pain, or life-threatening arrhythmias. Low-risk patients can be managed with a selective or ischemia-guided approach.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.