Cardiology · Pathway 122
NSTEMI
Key points
- Intermediate-or-higher-risk NSTEMI (GRACE predicted 6-month mortality > 3%) → coronary angiography (with follow-on PCI if indicated) within 72 hours of first admission.
- Clinically unstable — haemodynamic instability, refractory ischaemia or life-threatening arrhythmia → immediate coronary angiography.
- Metformin is best avoided during acute tissue ischaemia (lactic acidosis association).
- Management detail — see 'Acute Coronary Syndrome: Management of NSTEMI' chapter.
Decision points in this pathway
- Clinically unstable (haemodynamic instability, refractory ischaemia, life-threatening arrhythmia)?
- Intermediate or higher risk (GRACE 6-month mortality > 3%)?
The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.