Initial Conservative Versus Initial Invasive Strategies
ÎÎAn early invasive strategy (ie, diagnostic angiography with intent
to perform revascularization) is indicated in UA/NSTEMI patients
who have refractory angina or hemodynamic or electrical instability
(without serious comorbidities or contraindications to such
procedures). (I-B)
ÎÎAn early invasive strategy (ie, diagnostic angiography with intent to
perform revascularization) is indicated in initially stabilized
UA/NSTEMI patients (without serious comorbidities or
contraindications to such procedures) who have an elevated risk for
clinical events. (I-A)
ÎÎIt is reasonable to choose an early invasive strategy (within 12-24 h of
admission) over a delayed invasive strategy for initially stabilized highrisk patients with UA/NSTEMI. For patients not at high risk, a delayed
invasive approach is also reasonable. (IIa-B)
Immediate catheterization/angiography is recommended for unstable patients.
ÎÎIn initially stabilized patients, an initially conservative (ie, a
selectively invasive) strategy may be considered as a treatment
strategy for UA/NSTEMI patients (without serious comorbidities or
contraindications to such procedures) who have an elevated risk for
clinical events, including those who are troponin positive. (IIb-B)
The decision to implement an initial conservative (vs initial invasive)
strategy in these patients may be made by considering physician and
patient preference. (IIb-C)
ÎÎAn early invasive strategy (ie, diagnostic angiography with intent to
perform revascularization) is NOT recommended in patients with
extensive comorbidities (eg, liver or pulmonary failure, cancer), in
whom the risks of revascularization and comorbid conditions are likely
to outweigh the benefits of revascularization. (III: No Benefit-C)
ÎÎAn early invasive strategy (ie, diagnostic angiography with intent to
perform revascularization) is NOT recommended in patients with acute
chest pain and a low likelihood of ACS. (III: No Benefit-C)
ÎÎAn early invasive strategy (ie, diagnostic angiography with intent to
perform revascularization) should NOT be performed in patients who
will not consent to revascularization regardless of the findings.
(III: No Benefit-C)
27
