Treatment of NSTEMI with Low Risk of Ischemic Events and Normal Cardiac Biomarkers
Clinical Scenario
This protocol applies to patients presenting with Non-ST-elevation myocardial infarction (NSTEMI / NSTE-ACS) who are characterised by a low risk of ischemic events. The defining features of this subgroup are:
Normal cardiac biomarkers
Absence of high-risk features
No dynamic ST-segment changes
Management Approach
For this low-risk presentation, a selective invasive strategy is an appropriate approach. Prior to hospital discharge, noninvasive evaluation — such as stress testing or coronary CT angiography — is used to identify patients who may ultimately require invasive assessment.
The complete stepwise algorithm, including sequencing and decision criteria, is available in the full structured protocol.
References
- In patients with NSTE-ACS who are at low risk of ischemic events, either a routine invasive or selective invasive approach is recommended to help identify those who may require revascularization and to reduce MACE.
- These low-risk patients should still undergo noninvasive stress testing or coronary CT angiography prior to consideration of coronary angiography.
DOI: 10.1161/CIR.0000000000001309
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