A 65-year-old man with NSTEMI is managed conservatively. His GRACE score is 148. According to the ESC 2023 NSTEMI guidelines, what is the recommended timing for coronary angiography?
- A Immediately (< 2 hours) — emergent strategy
- B Electively at 72–96 hours
- C Within 24 hours (early invasive strategy) ✓
- D Deferred to 7 days after symptom resolution
Correct answer: C. Within 24 hours (early invasive strategy)
Explanation
ESC 2023 NSTEMI guidelines stratify patients by risk score. GRACE score > 140 (high risk) mandates an early invasive strategy — coronary angiography within 24 hours of admission. An emergent strategy (< 2 hours) is reserved for very-high-risk features such as haemodynamic instability, refractory ischaemia, or life-threatening arrhythmias. GRACE ≤ 109 (low risk) may be managed with selective invasive evaluation. A delay to 72–96 hours or beyond is not appropriate for a high-risk GRACE score.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.