Article Figures & Data
Figures
- Fig 1.
Current pathway for NSTE-ACS in the UK for DGH with angiogram only facilities. DGH = district general hospital; IHT = interhospital transfer; MAU = medical assessment unit; NSTE-ACS = non-ST elevation acute coronary syndrome; PCI = percutaneous coronary intervention.
- Fig 2.
Flowchart showing different pathways. A&E = accident and emergency; DGH = district general hospital; HAC-X = heart attack extension pathway; NSTE-ACS = non-ST elevation acute coronary syndrome.
Tables
> An invasive strategy (within 72 h) after first presentation is indicated in patients with at least one high-risk criterion (Box 2) and or recurrent symptoms. > Urgent coronary angiography (<2 h) is recommended in patients at very high ischaemic risk (refractory angina, associated heart failure, life-threatening ventricular arrhythmias or haemodynamic instability). > An early invasive strategy (<24 h) is recommended with a GRACE score >140 or with at least one primary high-risk criterion. > Non-invasive documentation of inducible ischemia is recommended in low-risk patients without recurring symptoms before deciding for invasive evaluation. > Likewise routine invasive evaluation of low-risk groups is not recommended. However, if there is a secondary high-risk criterion (Box 2) present in low-risk subset with GRACE <140, invasive evaluation can be delayed but is recommended to be carried out during the same hospital stay or preferably within 72 h of admission. ESC = European Society of Cardiology; GRACE = Global Registry of Acute Coronary Events. - Box 2.
High-risk criteria set out by ESC in the management and for evaluation of invasive angiography in patients presenting with NSTEMI.7
Primary criteria: > relative rise or fall in troponin > dynamic ST-T wave changes (with or without symptoms) > GRACE score >140. Secondary criteria: > diabetes mellitus > renal insufficiency (eGFR <60 mL/min/1.73 m2) > early post-infarction angina > recent PCI > previous CABG > intermediate or high GRACE risk score. NB: This is different to the GRACE score (for GRACE score visit gracescore.co.uk). CABG = coronary artery bypass surgery; eGFR = estimated glomerular filtration rate; ESC = European Society of Cardiology; GRACE = Global Registry of Acute Coronary Events; PCI = percutaneous coronary intervention
