Factors Associated with Appropriate Selection of Early Invasive Strategy or Ischemia-Guided Strategy in Pts with NSTE-ACS | |
| Immediate invasive (within 2 h) | Refractory angina |
| Signs or symptoms of heart failure or new or worsening mitral regurgitation | |
| Hemodynamic instability | |
| Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy | |
| Sustained ventricular tachycardia or ventricular fibrillation | |
| Early invasive (within 24 h) | None of the above, but GRACEa risk score >140 |
| Temporal change in troponin | |
| New or presumably new ST segment depression | |
| Delayed invasive (within 25-72 h) | None of the above but diabetes mellitus |
| Renal insufficiency (eGFR <60 mL/min per 1.73 m2 ) | |
| Reduced left ventricular systolic function (ejection fraction <0.40) | |
| Early postinfarction angina | |
| Percutaneous coronary intervention within 6 months prior | |
| Prior coronary artery bypass graft surgery | |
| GRACEa risk score 109-140 or TIMIb risk score ≥2 | |
| Ischemia-guided strategy | Low-risk score (e.g., TIMIb [0 or 1], GRACEa [<109]) |
| Low-risk, troponin-negative female pts | |
| Pt or clinician preference in the absence of high-risk features | |
a See CB Granger (Arch Intern Med 163:2345, 2003).
b See EM Antman (JAMA 284:835, 2000).
Abbreviations: eGFR, estimated glomerular filtration rate; GRACE, Global Registry of Acute Coronary Events; TIMI, Thrombolysis in Myocardial Infarction.
Source: Modified from Amsterdam EA et al: J Am Coll Cardiol 64:e139, 2014.