Treatment
18
Table 14. Factors Associated With Appropriate Selection
of Early Invasive Strategy or Ischemia-Guided
Strategy in Patients With NSTE-ACS
Immediate invasive
(within 2 h)
Refractory angina
Signs or symptoms of HF or new or worsening mitral regurgitation
Hemodynamic instability
Recurrent angina or ischemia at rest or with low-level activities
despite intensive medical therapy
Sustained VT or VF
Ischemia-guided
strategy
Low-risk score (e.g., TIMI [0 or 1], GRACE [<109])
Low-risk troponin-negative female patients
Patient or clinician preference in the absence of high-risk features
Early invasive
(within 24 h)
None of the above, but GRACE risk score >140
Temporal change in troponin
New or presumably new ST depression
Delayed invasive
(within 25-72 h)
None of the above but diabetes mellitus
Renal insufficiency (GFR <60 mL/min/1.73 m²)
Reduced LV systolic function (LVEF <0.40)
Early postinfarction angina
PCI within 6 mo
Prior CABG
GRACE risk score 109-140; TIMI score ≥2
