A 50-year-old with chest pain and a positive troponin but non-diagnostic ECG. What is the appropriate next step?

• A. Immediate thrombolysis
• B. Discharge home with analgesia
• C. Start high-dose statin only
• D. Serial ECGs and troponin testing; risk stratification with possible coronary intervention

Answer: (D)

When troponin is positive, this shows myocardial injury, and a non-diagnostic ECG means there isn’t a clear ST-elevation pattern. The appropriate approach is to treat this as an acute coronary syndrome with risk stratification and a plan for potential coronary intervention. Serial ECGs and repeated troponin measurements over time help confirm whether the injury is evolving and how high the risk is. Using risk scores guides decisions about how aggressively to pursue invasive strategies, such as coronary angiography and possible PCI or CABG. Immediate thrombolysis isn’t indicated here because there’s no STEMI pattern on the ECG, and thrombolysis carries bleeding risks without proven benefit in NSTEMI. Discharging with analgesia or using only a high-dose statin doesn’t address the acute event or risk optimization.