First 24 h in the management of non-ST segment elevation myocardial infarction

Non-ST elevation acute coronary syndrome comprises of unstable angina and non-ST segment elevation myocardial infarction (NSTEMI), depending upon normal or increase in cardiac biomarkers. NSTEMI patients are more prone to recurrent ischaemic events including risk of death or myocardial infarction because of subtotal occlusion of culprit coronary artery and ongoing myocardial ischaemia. The short-and long-term outcome in these patients can be improved by aggressive medical and/or interventional therapy instituted at the earliest possible. The goals of treatment are reliving ongoing ischaemia, prevent further thrombosis and correct haemodynamic and electric instability. The management includes pharmacotherapy with antiplatelet and antithrombotic drugs, glycoprotein IIb/IIIa inhibitors, nitrates and statins along with invasive treatment in selected group of patients. This article reviews the variables of risk stratification for recurrent ischemia or death, strategies of treatment within the first 24 hours after presentation and indications for invasive approach with coronary angioplasty.