Unstable angina
ICD-10 I20.0 · ICD-11 BA40.0

Unstable Angina Without Very High- or High-Risk NSTE-ACS Criteria and Low Index of Suspicion

When a patient presents with a working diagnosis of NSTE-ACS / unstable angina but does not meet very high-risk or high-risk criteria, and there is a low index of suspicion for NSTE-ACS, a different management pathway applies — one that departs from immediate invasive angiography.

Clinical Scenario

This protocol applies to patients with a working diagnosis of NSTE-ACS / unstable angina who:

In this group, a selective invasive strategy — guided by objective ischaemia testing or coronary imaging — is recommended before any decision to proceed to angiography.

Treatment Approach (Partial Overview)

For this low-suspicion, lower-risk NSTE-ACS presentation, management begins with acute supportive measures alongside antiplatelet and anticoagulant therapy. Coronary angiography is not performed immediately but is reserved for patients in whom ischaemia or obstructive coronary artery disease is subsequently confirmed.

The complete protocol specifies which therapies are used in sequence, their indications, and the criteria guiding escalation to invasive evaluation — see the full regimen for details.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehad191

A selective invasive approach is recommended in patients without very high- or high-risk NSTE-ACS criteria and with a low index of suspicion for NSTE-ACS.

A selective invasive approach after appropriate ischaemia testing or detection of obstructive CAD by CCTA is recommended in patients without very high- or high-risk features and a low index of suspicion for NSTE-ACS.

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