Box 1.

ESC recommendations for initial evaluation and angiography.7

> 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.