Acute myocardial ischaemia without persistent ST elevation. NSTEMI = troponin ↑; UA = negative.
Clinical features
- • Rest/crescendo chest pain
- • Similar to STEMI without ECG ST elevation
Investigations
- • Serial hs-troponin (0/1 h or 0/3 h algorithm)
- • ECG (ST↓, TWI, dynamic)
- • GRACE score for risk stratification
Diagnosis
- • Ischaemic symptoms + troponin rise/fall + ECG or imaging evidence
Differential diagnosis
- • Stable angina
- • Aortic dissection
- • PE
- • Musculoskeletal
- • GERD
Management
- • Aspirin + P2Y12 (ticagrelor preferred)
- • Fondaparinux 2.5 mg SC OD (or enoxaparin)
- • GRACE-guided angiography: high risk <24 h; intermediate <72 h; low = ischaemia testing
Drug therapy
- • β-blocker, ACEi, high-intensity statin
- • GTN for symptoms
- • Continue DAPT 12 months
Complications
- • Reinfarction, HF, arrhythmia, death
Clinical pearls
- • No fibrinolysis in NSTEMI
- • GRACE >140 = high risk → early invasive
References
- • ESC 2020 NSTE-ACS
- • AHA/ACC 2014 NSTEMI
Related in WardRound
Educational — verify locally.
