A 64-year-old man presents with NSTEMI. Risk stratification using the GRACE score gives him a score of 148. Per current ESC 2023 NSTEMI guidelines, the recommended invasive strategy is:
- A Immediate invasive strategy within 2 hours
- B Selective invasive strategy
- C Early invasive strategy within 24 hours ✓
- D Conservative medical management only
Correct answer: C. Early invasive strategy within 24 hours
Explanation
Per ESC 2023 NSTEMI guidelines, an immediate invasive strategy (<2 h) is reserved for very high-risk features (haemodynamic instability, cardiogenic shock, refractory chest pain, acute HF, or life-threatening arrhythmia). A GRACE score >140 mandates an early invasive strategy within 24 hours. Scores 109–140 also warrant early (<24 h) strategy. Selective (ischaemia-guided) strategy is for low-risk patients. A score of 148 clearly indicates early but not immediate strategy unless very high-risk features are also present.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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