A 55-year-old man with NSTEMI (GRACE score 148) is started on dual antiplatelet therapy and anticoagulation. According to current ESC guidelines, when should invasive angiography ideally be performed?
- A Within 2 hours (immediate)
- B Within 24 hours (early invasive) ✓
- C Within 72 hours
- D Elective at 5–7 days
Correct answer: B. Within 24 hours (early invasive)
Explanation
ESC 2020 NSTEMI guidelines recommend early invasive strategy (coronary angiography) within 24 hours for high-risk NSTEMI patients (GRACE score >140). Immediate angiography within 2 hours is reserved for very high-risk features (hemodynamic instability, cardiogenic shock, refractory chest pain, acute severe MR or VSD, sustained VT/VF, or STEMI on ECG). A GRACE score of 148 qualifies as high risk warranting the 24-hour window.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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