In a patient with NSTEMI, which feature MOST strongly mandates early invasive strategy within 2 hours (very high-risk criteria per ESC 2020)?
- A GRACE score > 140
- B Diabetes mellitus with positive troponin
- C Refractory angina with haemodynamic instability or cardiogenic shock ✓
- D Dynamic ST depression in ≥ 2 leads
Correct answer: C. Refractory angina with haemodynamic instability or cardiogenic shock
Explanation
Per the 2020 ESC NSTE-ACS guidelines, very high-risk criteria mandating immediate (within 2 hours) invasive strategy include: haemodynamic instability/cardiogenic shock, refractory chest pain despite maximal anti-ischaemic therapy, recurrent dynamic ECG changes or new ST elevations, life-threatening arrhythmias, and mechanical complications. A GRACE score >140 and dynamic ST depression require an early (<24 hours) rather than immediate strategy. Diabetes alone does not trigger immediate catheterisation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.