In NSTEMI management, which clinical finding categorises a patient as 'very high risk' mandating immediate invasive strategy (within 2 hours) per ESC 2023 guidelines?

• A GRACE score above 140
• B Troponin above 5 times upper limit of normal
• C New ST depression in 6 or more leads
• D Haemodynamic instability or cardiogenic shock ✓

Explanation

ESC 2023 NSTE-ACS guidelines define very-high-risk criteria requiring immediate invasive strategy (within 2 hours) as: haemodynamic instability or cardiogenic shock, recurrent/refractory chest pain, life-threatening arrhythmias, mechanical complications of MI, or acute heart failure. GRACE score >140 mandates early invasive strategy (within 24 hours). Troponin elevation alone and widespread ST depression are high-risk but do not automatically reach the immediate 2-hour threshold.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.