Selection of Initial Treatment Strategy for Patients With Non-ST-Elevation ACS: Invasive Versus Conservative Strategy*

Preferred Strategy Patient Characteristics
Invasive
  • Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy

  • Elevated cardiac biomarkers (TnT or TnI)

  • New or presumably new ST-segment depression

  • Signs or symptoms of HF or new or worsening mitral regurgitation

  • High-risk findings from noninvasive testing

  • Hemodynamic instability

  • Sustained ventricular tachycardia

  • PCI within 6 months

  • Prior CABG

  • High-risk score (eg, TIMI, GRACE)

  • Reduced LV function (LVEF less than 40%)

Conservative
  • Low-risk score (eg, TIMI, GRACE)

  • Patient or physician preference in absence of high-risk features

  • CABG indicates coronary artery bypass graft surgery; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; LV,
    left ventricular; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; TIMI, Thrombolysis in
    Myocardial Infarction; TnI, troponin I; and TnT, troponin T.

  • * Adapted from the ACC/AHA 2007 UA/NSTEMI Guidelines.