![]() Platelet glycoprotein IIb/IIIa inhibitors have an ACC/AHA class I indication in patients for whom catheterization and percutaneous coronary intervention are planned. When elective coronary artery bypass grafting is planned, clopidogrel should be withheld for five to seven days. The updated ACC/AHA guideline considers the use of clopidogrel in addition to aspirin to have a class I indication in patients with UA/NSTEMI who are undergoing an early noninterventional or interventional approach and are not at high risk for bleeding. The updated ACC/AHA guideline recommends use of the thienopyridine clopidogrel (Plavix) in patients who cannot tolerate aspirin (ACC/AHA class I). Medical treatment includes anti-ischemic therapy (oxygen, nitroglycerin, beta blocker), antiplatelet therapy (aspirin, clopidogrel, platelet glycoprotein IIb/IIIa inhibitor), and antithrombotic therapy (heparin, low-molecular-weight heparin). Hospital care consists of appropriate initial triage and monitoring. During the initial evaluation, the history, physical examination, electrocardiogram, and cardiac biomarkers are used to determine the likelihood that the patient has UA/NSTEMI and to aid in risk assessment when the diagnosis is established. Part I of this two-part article discusses the first two components of management. Management of suspected UA/NSTEMI has four components: initial evaluation and management hospital care coronary revascularization and hospital discharge and post-hospital care. This guideline, which was published in 2000 and updated in 2002, highlights recent medical advances and is a practical tool to help physicians provide medical care for patients with UA/NSTEMI. To help standardize the assessment and treatment of these patients, the American College of Cardiology and the American Heart Association convened a task force to formulate a management guideline. hospitals because of unstable angina and non–ST-segment elevation myocardial infarction (UA/NSTEMI). In hospitalized NSTEMI patients with high risk of clinical events, early PCI is associated with improved 28-day survival.Ĭoronary delayed early percutaneous revascularization.Each year, more than 1 million patients are admitted to U.S. By 1-year of follow up, there was no significant difference in mortality with respect to early vs. After accounting for potential confounders, early PCI was associated with a 58% reduced 28-day mortality (OR = 0.42 95% CI: 0.21-0.84) for the entire population, and 57% reduced mortality (OR = 0.43 95% CI: 0.21-0.88) for high risk patients. The 28-day and 1-year mortality were 2% and 5%, respectively. Most were white (79%), male (68%), with mean age 61 years. Associations between early versus late PCI and mortality were analyzed using multivariable logistic regression adjusted for demographics, hospitalization year, TIMI score, and comorbidities.įrom 1987 to 2012, 6,746 patients were hospitalized with NSTEMI and underwent PCI. Patients were stratified into low (TIMI score 2-4), and high risk (TIMI score 5-7, or presence of cardiogenic shock, ventricular fibrillation, or cardiac arrest). We limited our study to patients undergoing early (<24 hr of the event onset), or late (≥24 hr) percutaneous coronary intervention (PCI). ![]() NSTEMI was classified using a validated algorithm. The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. The real-world effectiveness of this strategy is unknown. A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI).
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