A 60-year-old man with NSTEMI is risk-stratified using the GRACE 2.0 score and found to be high risk. According to current ESC NSTEMI guidelines (2020), within what timeframe should coronary angiography be performed?
- A Within 24 hours (early invasive strategy) ✓
- B Within 2 hours (immediate strategy)
- C Within 72 hours (routine invasive strategy)
- D After 72 hours following optimal medical therapy
Correct answer: A. Within 24 hours (early invasive strategy)
Explanation
ESC 2020 NSTEMI guidelines recommend an early invasive strategy (coronary angiography within 24 hours) for high-risk patients, defined by GRACE score >140 or dynamic ECG changes or elevated troponin. Immediate angiography (within 2 hours) is reserved for very-high-risk features such as refractory ischaemia, haemodynamic instability, or electrical instability. The 72-hour window is for patients with intermediate risk. Delayed or elective strategies are used for low-risk patients with a negative non-invasive test.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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