What are the ACCF/AHA guidelines for use of percutaneous coronary intervention (PCI) in the treatment of NSTE-ACS?

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

The 2014 ACC Foundation/AHA guidelines for management of unstable angina/NSTEMI recommend the use of an early invasive strategy or ischemia-guided strategy in patients with NSTE-ACS. An ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109). Other patients will benefit from an early invasive strategy stratified by timing as follows:

  • Immediate (within 2 hours) - Patients with refractory or recurrent angina with 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 past 6 months, prior CABG, GRACE risk score of 109-140, or TIMI score of 2 or higher

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