Factors, Early Invasive Strategy or Ischemia-Guided Strategy in Patients with NSTE-ACS

해리슨 19판 내용[J Am Coll Cardiol 61:e179, 2013]은 다음과 같습니다.

 

해리슨 20판 내용[ J Am Coll Cardiol 64:e139, 2014.]은 다음과 같습니다.
Early invasive (within 24 h) strategy가 필요한 경우는 
 1. GRACE^a risk score >140
 2. Temporal change in troponin
 3. New or presumably new ST segment depression 입니다.

Refractory angina, Signs or symptoms of heart failure or new or worsening mitral regurgitation, Hemodynamic instability, Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy, Sustained ventricular tachycardia or ventricular fibrillation는 immediate invasive (within 2 h) strategy가 필요한 경우입니다.

The three strategies are:
▣The strategy of immediate angiography followed by revascularization takes place soon after the diagnosis and is indicated for patients assessed to have a poor short-term (or long-term) prognosis due the non-ST elevation acute coronary syndrome (NSTEACS).

▣The invasive strategy of angiography followed by revascularization is aimed at improving long-term prognosis. In these patients, angiography followed by revascularization is intended and usually performed within 4 to 48 hours of admission. Some experts refer to intended angiography within 24 hours as an early invasive approach and intended angiography within 48 hours a delayed invasive approach.

▣The conservative strategy begins with rapidly intensifying medical therapy. Patients who become asymptomatic on this regimen are given several days to "cool off," during which time intravenous medications are discontinued. If the patient remains symptom-free, stress testing is performed, most often with some form of myocardial imaging (nuclear or echocardiography). Persistence of symptoms, symptom recurrence, or a positive stress test should lead to prompt cardiac catheterization. 

REF. UpToDate 2018.09.30
        Harrison's 20th edition