Choice of management strategy in patients with non-ST-elevation myocardial infarction or unstable angina

ACS: acute coronary syndrome; CAD: coronary artery disease; LV: left ventricular; MI: myocardial infarction; NSTEMI: non-ST segment elevation MI.

* The management described in this algorithm is appropriate for thrombotic MI (ie, type I MI). For information on type II MI (ie, nonthrombotic MI), refer to UpToDate topics on the diagnosis and management of MI.

¶ For information on choice and timing of a noninvasive imaging study for obstructive CAD, refer to UpToDate topics on management of ACS in the emergency department.

Δ Evidence of obstructive CAD includes anatomic evidence of ≥70% stenosis of an epicardial artery or inducible ischemia with stress testing (eg, echocardiography, nuclear perfusion imaging).

◊ For most patients undergoing an invasive strategy, angiography within 48 hours of diagnosis is reasonable. In patients who cannot undergo invasive angiography or who choose not to, noninvasive imaging is a reasonable option for assessment of obstructive CAD.

§ For inpatients, angiography should occur before discharge. For outpatients, angiography should generally be scheduled within the next 7 days or, if the patient has high-risk features on anatomic imaging (eg, left main coronary artery disease), angiography should occur more urgently.