A 65-year-old man with NSTEMI has a GRACE score of 155. He is on aspirin, ticagrelor, fondaparinux, and a beta blocker. Which statement about the timing of coronary angiography in this patient is MOST aligned with current ESC NSTEMI guidelines?

• A Immediate angiography (<2 hours) regardless of clinical status
• B Angiography at 48-72 hours (selective invasive strategy)
• C Early angiography within 24 hours (very high-risk: GRACE >140) ✓
• D Conservative non-invasive management; angiography only if recurrent ischaemia

Explanation

ESC 2020 NSTEMI guidelines stratify timing: immediate (<2 hours) for haemodynamic instability, cardiac arrest, refractory chest pain, or acute HF; early invasive strategy (<24 hours) for GRACE >140 (very high risk) or elevated troponins with ischaemic ECG changes; delayed invasive (24-72 hours) for intermediate-risk (GRACE 109-140); selective conservative for low risk. This patient has GRACE 155 (very high risk), so early angiography within 24 hours is indicated, not immediate (as he is haemodynamically stable).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.