Key result
An early invasive strategy in NSTE-ACS patients should prioritize individuals with a GRACE risk score >140 over those with isolated troponin rise or ECG changes.
Why the study?
Current ESC guidelines classify the majority of NSTE-ACS patients as high-risk, prompting a proposal to refine prioritization and same-day transfer criteria.
Does an early invasive strategy improve clinical outcomes in specific high-risk subgroups of NSTE-ACS patients?
Does an early invasive strategy improve clinical outcomes in specific high-risk subgroups of NSTE-ACS patients?
Same-day transfer and early invasive strategy (<24h) in NSTE-ACS should be prioritized for patients with a GRACE score >140 or very-high-risk criteria, rather than all patients with isolated troponin or ECG changes.
Answers are grounded in this paper and cite their sources.
Supports GRACE >140 prioritization for early invasive NSTE-ACS care; leaves open prospective trial confirmation.
An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as "high-risk". We propose to prioritise patients with a global registry of acute coronary events (GRACE) risk score >140 over patients with isolated troponin rise or electrocardiographic changes and a GRACE risk score <140. We also acknowledge that same-day transfer for all patients at a high risk is not necessary in the Netherlands since the majority of Dutch cardiology departments are equipped with a catheterisation laboratory where diagnostic coronary angiography is routinely performed in NSTE-ACS patients. Therefore, same-day transfer should be restricted to true high-risk patients (in addition to those NSTE-ACS patients with very high-risk (VHR) criteria) in centres without coronary angiography capabilities.
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Zwart et al. (2019) conducted an editorial in Non-ST-elevation acute coronary syndrome (NSTE-ACS). Early invasive strategy vs. Delayed invasive strategy was evaluated. An early invasive strategy in NSTE-ACS patients should prioritize individuals with a GRACE risk score >140 over those with isolated troponin rise or ECG changes.
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