Affiliation: | 1.Department of Cardiology, Catharina ziekenhuis, Eindhoven, The Netherlands ;2.Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands ;3.Department of Cardiology, Maastricht University Medical Center (UMC)+, Maastricht, The Netherlands ;4.Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, The Netherlands ;5.Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands ;6.Department of Cardiovascular Medicine, Medical Faculty, University of Münster, Münster, Germany ;7.Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands ;8.Department of Cardiology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands ;9.Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands ; |
Abstract: | An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as “high-risk”. We propose to prioritise patients with a global registry of acute coronary events (GRACE) risk score >140 over patients with isolated troponin rise or electrocardiographic changes and a GRACE risk score <140. We also acknowledge that same-day transfer for all patients at a high risk is not necessary in the Netherlands since the majority of Dutch cardiology departments are equipped with a catheterisation laboratory where diagnostic coronary angiography is routinely performed in NSTE-ACS patients. Therefore, same-day transfer should be restricted to true high-risk patients (in addition to those NSTE-ACS patients with very high-risk (VHR) criteria) in centres without coronary angiography capabilities. |