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Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] 2014 AHA/ACC guideline for the management of patients with non-ST elevation acute coronary syndromes. Circulation 2014 2.
This is surprisingly common, and several studies of continuous 12-lead ECG monitoring in the setting of admitted unstable angina report high rates (15%) of silent transient myocardial ischemia (ST elevation), and that these findings were strong independent predictors of MI or death during hospitalization. Patel et al., Krucoff et al.)
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