Treatment of Unstable Angina with High-Risk ECG Changes or Elevated GRACE Score (NSTE-ACS, Without Very High-Risk Features)
This protocol addresses patients with a working diagnosis of NSTE-ACS / unstable angina who do not fulfil very high-risk criteria but carry at least one high-risk feature that calls for prompt, structured inpatient management.
Defining High-Risk Criteria — This Scenario
At least one of the following must be present:
- Dynamic ST-segment or T wave changes on ECG
- Transient ST-segment elevation
- GRACE risk score >140
Management Approach
The cornerstone of management is an early inpatient invasive strategy — coronary angiography within 24 hours — alongside structured antiplatelet and anticoagulation therapy.
The complete drug selection, agent sequencing, and full procedural protocol are available via the link below.
References
DOI: 10.1093/eurheartj/ehad191
- An early invasive strategy within 24 h should be considered in patients with at least one of the following high-risk criteria: Dynamic ST-segment or T wave changes; Transient ST-segment elevation; GRACE risk score >140.
- An early invasive strategy refers to routine invasive angiography (and PCI if needed) within 24 h of presentation.
- An invasive strategy during hospital admission is recommended in NSTE-ACS patients with high-risk criteria or a high index of suspicion for unstable angina.
- In all ACS patients, a P2Y12 receptor inhibitor is recommended in addition to aspirin, given as an initial oral LD followed by an MD for 12 months unless there is HBRc.
- Parenteral anticoagulation is recommended for all patients with ACS at the time of diagnosis.
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