Highlights & Basics
- Non-ST-elevation myocardial infarction (NSTEMI) is part of the acute coronary syndrome spectrum.
- Symptoms are indistinguishable from those of unstable angina. Most patients present with chest pain. However, NSTEMI is differentiated from unstable angina by a rise in level of cardiac troponin.
- ECG, biomarkers (high-sensitivity troponin), and echocardiogram are the first-line investigations in all patients. Other investigations (e.g., chest x-ray and computed tomography chest) are useful to exclude other conditions.
- Early risk stratification and treatment with anti-ischemic (beta-blockers, nitrates), anticoagulant (heparin), and dual antiplatelet agents (aspirin plus a P2Y12 inhibitor) is needed. Higher-risk patients should be considered for an early invasive strategy (coronary angiography and revascularization in 12-24 hours).
- Complications are progression or worsening of myocardial infarction, heart failure, cardiogenic shock, arrhythmias, and death.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
ECG showing ST depression
ECG showing ST depression
64-slice CT angiography (A) and conventional angiography (B) showing a high-grade lesion in the mid-right coronary artery, indicated by the arrows. The arrowheads show artifacts that may be mistaken for lesions
64-slice CT angiography of a patient with stable angina showing 3D reconstruction (A), curved reformatted images (B) and confirmation of a high-grade lesion on conventional angiography (C). The arrowheads show calcified plaques. Dx= diagnosis
Citations
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-228.[Abstract][Full Text]
Thygesen K, Alpert JS, Jaffe AS, et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018 Oct 30;72(18):2231-64.[Abstract][Full Text]
Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-367.[Abstract][Full Text]
Writing Committee Members; Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee On Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.[Abstract][Full Text]
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee On Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18-114.[Abstract][Full Text]
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