When is percutaneous coronary intervention (PCI) indicated in patients with NSTE-ACS?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

For patients with NSTE-ACS, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on the management of NSTE-ACS (updated in 2014 [1] ) recommend an early invasive strategy in most cases, with timing as follows:

  • Immediate (within 2 hours) - Patients with refractory angina, recurrent angina after initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation
  • Early (within 24 hours) - None of the immediate characteristics but new ST-segment depression, a GRACE risk score >140, or temporal change in troponin
  • Delayed invasive (within 25-72 hours) - None of the immediate or early characteristics but renal insufficiency (glomerular filtration rate [GFR] < 60 mL/min/1.73 m 2), left ventricular ejection fraction (LVEF) < 40%, early postinfarct angina, history of PCI within the preceding 6 months, prior CABG, GRACE risk score of 109-140, or TIMI score of 2 or higher

Ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109).

See Overview for more detail.


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