18
Treatment
Coronary Angiography and Revascularization in Patients With
NSTE-ACS
COR LOE
Recommendations
1 A 1. In patients with NSTE-ACS who are at elevated risk of
recurrent ischemic events and are appropriate candidates
for revascularization, an invasive strateg y with the intent
to proceed with revascularization is indicated to reduce
cardiovascular events.
1 B-R 2. In patients with NSTE-ACS and cardiogenic shock who
are appropriate candidates for revascularization, emergency
revascularization is recommended to reduce risk of death.
1 C-LD 3. In appropriate patients with NSTE-ACS who have refractory
angina or hemodynamic or electrical instability, an immediate
invasive strateg y with intent to perform revascularization is
indicated to improve outcomes.
2a B-R 4. In patients with NSTE-ACS who are initially stabilized and
are at high risk of clinical events, it is reasonable to choose
an early invasive strateg y (within 24 hours) over a delayed
invasive strateg y to improve outcomes.
2a B-R 5. In patients with NSTE-ACS who are initially stabilized and
are at intermediate or low risk of clinical events, an invasive
strateg y with intent to perform revascularization is reasonable
before hospital discharge to improve outcomes.
2a B-NR 6. In patients with NSTE-ACS who have failed PCI and have
ongoing ischemia, hemodynamic compromise, or threatened
occlusion of an artery with substantial myocardium at risk,
who are appropriate candidates for CABG, emergency CABG
is reasonable.
3: Harm B-R 7. In patients with NSTE-ACS who present in cardiogenic
shock, routine multivessel PCI of non-culprit lesions in the
same setting should NOT be performed.
Revascularization in NSTE-ACS
