30th May 2026

Management

• Initial Treatment: Aspirin, sublingual GTN, morphine, oxygen (if SpO₂ <90%).
• Anticoagulation: Fondaparinux or heparin.
• Urgent Coronary Angiography (ICA): For unstable patients or those with high-risk features (ongoing pain, instability, arrhythmias, high-risk comorbidities, or high-risk stratification scores).
• Long-term Treatment: Dual antiplatelet therapy (for at least 12 months), beta-blockers, ACE inhibitors/ARBs, statins, aldosterone antagonists (for HF), and SGLT2 inhibitors (for HF).

Prevention & Follow-Up

• Primary Prevention: Smoking cessation, healthy diet, regular physical activity, and statin therapy for high-risk individuals.
• Secondary Prevention: Lifestyle changes, cardiac rehab, and long-term medication adherence.
• Obesity is a significant modifiable risk factor, and weight management and lifestyle modification are key to reducing the risk of future cardiovascular events. 
• Smoking is also known to be a well-established risk factor linked to recurrent cardiovascular events, and smoking cessation should be encouraged in all patients.
• Follow-up: Outpatient visit 1-2 weeks post-discharge, lipid monitoring every 6 months, and regular medication reviews.

Complications

• Short-term: Cardiac arrhythmias, acute heart failure, cardiogenic shock, acute mitral regurgitation, post-MI pericarditis, venous thromboembolism (VTE).
• Variable: Depression, in-stent thrombosis.

Prognosis

NSTEMI patients face high morbidity and mortality risks, with a 4-6 times higher risk of sudden death than the general population. Key risk factors include diabetes, smoking, heart failure, and infarct extent. Modern treatments (statins, revascularisation) reduce mortality, but age and other factors temper the benefits. Cardiovascular death risk post-MI is about 10% in the first year, with lifestyle changes and cardiac rehab improving survival.