Cardiology
NSTEMI
비ST상승심근경색
MI from partial coronary occlusion without ST elevation (troponin positive)
- How common
- More common than STEMI
- Typical age
- More common in 60s+
What is it?
Plaque rupture causing partial occlusion or transient total occlusion → subendocardial necrosis with collateral flow.
Commonly affected: Subendocardial myocardium, partially occluded artery distribution
How it develops
- Plaque rupture/erosionErosion of less vulnerable plaque
- Partial thrombosisNon-occlusive thrombus
- Subendocardial ischemiaECG: ST depression or T wave inversion
- Myocyte necrosisTroponin rises, no Q waves
Symptoms
- Chest pressureSimilar but less severe than STEMI
- DyspneaOften main symptom in elderly/DM
- FatigueAtypical presentations common
- DiaphoresisSympathetic activation
How it is examined
- ECG analysisST depression or T wave inversion (no ST elevation)
- Serial troponinAdmission, 3 hr, 6 hr (high-sensitivity)
- TIMI/GRACE risk scoreDecide early invasive strategy
Imaging
CXR for pulmonary edema.
- Pulmonary congestion
Coronary angiography within 24-72 hrs (immediate if high risk).
- Plaque/stenosis
- Non-occlusive thrombus
Non-surgical care
- DAPTAspirin + ticagrelor/clopidogrel
- AnticoagulationLMWH (enoxaparin) or fondaparinux
- Beta-blockerReduce HR and O2 demand
- High-intensity statinAtorvastatin 80mg
- ACE inhibitorLV protection
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
High risk (TIMI ≥3, ongoing pain, hemodynamic instability)
Procedures that may be discussed
- Early invasive strategy (PCI within 24-72 hrs)
- CABG (multivessel disease)
Outlook
6-mo mortality slightly lower than STEMI, but ≥1 yr mortality similar or higher (recurrence).