For a patient with NSTEMI and risk factors, which strategy for reperfusion is best?

An early invasive strategy is the best approach for a patient with non-ST elevation myocardial infarction (NSTEMI) who presents with risk factors. This strategy involves early coronary angiography and potentially revascularization, typically with percutaneous coronary intervention (PCI), for patients who are at high risk for further adverse events.

In individuals with NSTEMI, especially those exhibiting risk factors such as elevated cardiac biomarkers, a history of coronary artery disease, diabetes, or other significant cardiovascular issues, there is a well-documented benefit of early intervention. This approach has been shown to reduce morbidity and mortality by addressing significant coronary artery blockages before the patient experiences additional ischemic complications.

In contrast, conservative management may not sufficiently address the underlying coronary ischemia in high-risk patients and may leave them vulnerable to further cardiac events. Immediate primary PCI is typically reserved for ST-elevation myocardial infarction (STEMI) cases rather than NSTEMI. Finally, coronary artery bypass grafting (CABG) is a more invasive surgical intervention that is usually indicated in cases of severe multi-vessel disease or after initial stabilization rather than as an immediate reperfusion strategy.

Thus, selecting an early invasive strategy for high-risk NSTEMI patients aligns with clinical guidelines and evidence