THERAPEUTIC MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION WITHOUT ST-SEGMENT ELEVATION: INITIAL STRATEGIES

Abstract

Non-ST-segment elevation myocardial infarction (NSTEMI) is a prevalent manifestation of acute coronary syndromes, characterized by high clinical heterogeneity and significant diagnostic challenges. This narrative review analyzes initial management strategies, highlighting the overcoming of the classic dichotomy between STEMI and NSTEMI in favor of the myocardial occlusion (MOI) paradigm. Evidence indicates that up to 34% of patients with NSTEMI present with acute total coronary occlusion, identifiable by subtle electrocardiographic patterns (Aslanger, De Winter, Wellens) and by the use of ultrasensitive troponins. The study discusses the timing of invasive intervention, recommending immediate revascularization (< 2h) for unstable patients and early revascularization (< 24h) for the high-risk subgroup (GRACE > 140). In the multivessel setting, data from the SWEDEHEART registry suggest the superiority of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). It is concluded that effective management requires dynamic and individualized risk stratification to optimize myocardial salvage and reduce morbidity and mortality.