Appropriate Selection of Routine Invasive Versus Ischemia-Driven Revascularization Strategy in Patients With NSTEMI/UA
| Immediate/urgent invasive (within 2 h) | - Refractory Angina
- Worsening Signs or Symptoms of heart failure or Mitral regurgitation
- Hemodynamic instability or Shock
- Sustained VT or VF
| | Ischemia-driven | - Low-risk score (TIMI ≤ 1 or GRACE < 109)
- Low-risk biomarker-negative female patients
- Patient or clinician preference in the absence of high-risk features
| | Early invasive (within 24 h) | - None of the above but a high-risk score (TIMI ≥ 3 or GRACE > 140)
- Rapid rate of rise in biomarkers
- New or presumably new ST depressions
| | Delayed invasive (24–72 h) | - None of the above but presence of diabetes
- Renal insufficiency (GFR < 60)
- LV ejection fraction <40%
- Early postinfarction angina
- Prior PCI within 6 months
- Prior CABG
- TIMI score ≥2 or GRACE score 109–140 and no indication for early invasive strategy
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CABG, coronary artery bypass graft; GFR, glomerular filtration rate; GRACE, Global Registry of Acute Coronary Events; LV, left ventricular; NSTEMI, non–ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; TIMI, Thrombolysis in Myocardial Infarction; UA, unstable angina; VF, ventricular fibrillation; VT, ventricular tachycardia.