Give an overview concerning the management of NSTEMI/UA.
Patients with NSTE-ACS are classified based on the presence (NSTEMI) or absence (UA) of significantly elevated cardiac troponin (cTn) levels.
A key element of management is to assess the necessity for and timing of PCI (fibrinolytics are not indicated in NSTE-ACS).
Multiple risk scores (e.g., HEART, TIMI, GRACE) can help to determine an adequate strategy but are no substitute for individual clinical judgment.
Dual antiplatelet therapy and anticoagulation is indicated initially and the preferred regimens vary based on patient risk factors and timing of revascularization.
Some low-risk NSTE-ACS patients can be managed conservatively.
List ECG changes in NSTEMI/UA.
No ST elevations present
Nonspecific signs of ischemia may be present, including:
ST depression, especially if horizontal or downsloping
Transient ST deviations
To identify STEMI or STEMI-equivalent ECG findings, repeat ECGs if the initial one is inconclusive or any changes in symptoms occur.
Describe the risk-dependet timing of revascularization.
Management of NSTE-ACS depends on a patient's mortality risk (e.g., TIMI score), clinical findings, and the availability of resources.
Invasive strategy for NSTE-ACS (very high- to intermediate-risk patients): coronary angiography within 2–72 hours
Ischemia-guided strategy for NSTE-ACS (in stable, low-risk patients): noninvasive cardiac stress testing (e.g., exercise ECG, stress echocardiography) to evaluate the need for coronary angiography
Fibrinolytic therapy is not indicated in patients with unstable angina or NSTEMI.