Invasive management of NSTEACS

Clinical trials have demonstrated the benefit of early invasive management for non–ST elevation acute coronary syndrome (NSTEACS)—invasive coronary angiography to determine the coronary anatomy, and revascularisation (ie stenting or bypass surgery).

The recommended time to invasive management of a patient with NSTEACS is determined by the level of acute risk (see Overview of management of non-ST elevation acute coronary syndrome (NSTEACS)):

• very high risk—invasive management is recommended within 2 hours of diagnosis
• high risk—invasive management is recommended within 24 hours of diagnosis.

Every effort should be made to meet these recommended timeframes; however, if these timeframes are not feasible, aim for invasive management as early as possible. Thrombolytic therapy is not an option for NSTEACS, including if the recommended timeframes for invasive management cannot be met.

Patients with NSTEACS without troponin elevation or any other features of high or very high risk (see Overview of management of non-ST elevation acute coronary syndrome (NSTEACS)) are considered to have low-risk unstable angina. They require ongoing assessment and investigations. Depending on the results of these investigations, or if there is a change in their risk stratification, invasive management may be required. See #[Low-risk unstable angina] for more information.