A patient with NSTEMI has a GRACE score of 148 (>140 = high risk). According to current ESC guidelines, the optimal timing for coronary angiography is:
- A Within 2 hours (immediate)
- B Within 24 hours ✓
- C Within 72 hours
- D Electively after discharge
Correct answer: B. Within 24 hours
Explanation
ESC 2020 NSTEMI guidelines stratify patients by risk: very high-risk (haemodynamic instability, refractory chest pain, cardiogenic shock) → immediate (<2h) angiography; high-risk (GRACE >140, dynamic ST changes, elevated troponin, new LV dysfunction) → early (<24h) angiography. GRACE ≤140 with no other high-risk features is managed with angiography within 72 hours (selective invasive strategy). The TIMACS and VERDICT trials support an early (<24h) strategy in high-risk NSTEMI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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