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NSTEMI with high-risk features — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsNSTEMI with high-risk featuresSCE Acute Medicine

A 73-year-old woman presents with recurrent chest pain at rest and dynamic ST depression in V4-V6. Troponin is elevated and eGFR is 48 mL/min/1.73 m2. She is pain-free after nitrates but has diabetes and prior PCI. GRACE score is calculated as 162. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Admit for early invasive coronary angiography

A high GRACE score with dynamic ECG changes indicates high-risk NSTEMI and supports early invasive angiography. CT coronary angiography is useful in selected low-risk chest pain pathways, not high-risk NSTEMI. Fibrinolysis is not used for NSTEMI. The pearl is that NSTEMI management depends on ischaemic risk, bleeding risk and timing rather than troponin positivity alone.

Reference: NICE NG185