A 62-year-old man presents with NSTEMI. His TIMI risk score for NSTEMI is calculated to be 5. According to current ACC/AHA guidelines, what is the recommended strategy?
- A Early invasive strategy with coronary angiography within 24–48 hours ✓
- B Conservative (ischemia-guided) management with medical therapy alone
- C Immediate (within 2 hours) coronary angiography regardless of stability
- D Thrombolysis with tenecteplase followed by delayed angiography
Correct answer: A. Early invasive strategy with coronary angiography within 24–48 hours
Explanation
A TIMI risk score of ≥3 for NSTEMI identifies high-risk patients who benefit from an early invasive strategy (angiography within 24–48 hours) over a conservative approach. Immediate angiography (<2 hours) is reserved for very high-risk features (refractory ischemia, haemodynamic instability, sustained VT, cardiogenic shock). Thrombolysis has no role in NSTEMI. The TACTICS-TIMI 18 and FRISC-II trials established the benefit of early invasive strategy in higher-risk NSTEMI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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