Treatment of Unstable Angina When Very High-Risk NSTE-ACS Criteria Are Present

This protocol applies to patients with a working diagnosis of NSTE-ACS or unstable angina who present with at least one very high-risk criterion requiring an immediate invasive strategy. These criteria signal an urgent, high-stakes clinical picture that demands prompt action.

Any of the following qualifies:

• Haemodynamic instability or cardiogenic shock
• Recurrent or refractory chest pain despite medical treatment
• In-hospital life-threatening arrhythmias
• Mechanical complications of myocardial infarction
• Acute heart failure presumed secondary to ongoing myocardial ischaemia
• Recurrent dynamic ST-segment or T wave changes on ECG (including intermittent ST-segment elevation)

When coronary anatomy or prior percutaneous intervention determines the revascularization route, a surgical approach to the coronary circulation becomes the indicated intervention.

The complete protocol — including the full decision pathway, specific procedural thresholds, and step-by-step management — is available via the link below.