• August 21, 2012 – 11:00

    2012 Updated ACCF/AHA Guidelines for Unstable Angina and Non-ST-Elevation Myocardial Infarction

    Recent guideline updates for unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI) recommend the following:

    • Aspirin should be administered to UA/NSTEMI patients as soon as possible after hospital presentation and continued indefinitely to patients who do not have contraindications
    • A loading dose followed by daily maintenance dose of either clopidogrel, prasurgel, or ticagrelor should be administered to UA/NSTEMI patients who are unable to take aspirin
    • After cardiovascular stress testing, the patient is classified as:
      • Not at low risk, diagnostic angiography should be performed
      • At low risk, continue aspirin indefinitely, continue clopidogrel or ticagrelor for up to 12 months, continue unfractionated heparin for 48 hours
      • For UA/NSTEMI patients in who coronary artery bypass grafting (CABG) is selected as a postangiography management strategy, continue aspirin and unfractionated heparin
      • Diagnostic angiography with intent to perform revascularization is indicated in initially stabilized UA/NSTEMI patients without serious comorbities who have an elevated risk for clinical events
      • It is reasonable to choose an early invasive strategy (within 12 to 24 hours of admission) over a delayed invasive strategy for initially stabilized high-risk patients with UA/NSTEMI
      • For UA/NSTEMI patients treated with a stent, aspirin should be continued indefinitely with clopidogrel 75mg daily, prasurgel 10mg daily or ticagrelor 90mg twice daily for at least 12 months in patients receiving a drug-eluting stent
      • Medical treatment in acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with or without diabetes
      • Creatinine clearance should be estimated in patients with UA/NSTEMI and the doses of renally-cleared medications should be adjusted according to the pharmacokinetics of specific medications

    Reference: Jneid H, Anderson JL, Wright RS, et al.  2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update).  Circulation 2012;126:875-910.