AHA/ACC Guideline for the Management of Patients With Non–ST- Elevation Acute Coronary Syndromes. Table of Contents. Preamble e. 34. 6Introduction e. Methodology and Evidence Review e. Organization of the GWC e. Document Review and Approval e. Scope of the CPG e. Overview of Acs e. Definition of Terms e. Epidemiology and Pathogenesis e. Epidemiology e. 34. Pathogenesis e. 35. Initial Evaluation and Management e. Background and Purpose— The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute.![]() Clinical Assessment and Initial Evaluation: Recommendation e. ED or Outpatient Facility Presentation: Recommendations e. Diagnosis of NSTE- ACS e. History e. 35. 23. Physical Examination e. Search metadata Search full text of books Search TV captions Search archived web sites Advanced Search. International programme on chemical safety environmental health criteria 6 principles and methods for evaluating the toxicity of chemicals part i this report. Electrocardiogram e. Biomarkers of Myocardial Necrosis e. Imaging e. 35. 33. Prognosis–Early Risk Stratification: Recommendations e. Rationale for Risk Stratification and Spectrum of Risk: High, Intermediate, and Low e. Estimation of Level of Risk e. History: Angina Symptoms and Angina Equivalents e. Demographics and History in Diagnosis and Risk Stratification e. Early Estimation of Risk e. Electrocardiogram e. Physical Examination e. Cardiac Biomarkers and the Universal Definition of MI: Recommendations e. Biomarkers: Diagnosis e. Biomarkers: Prognosis e. Cardiac Troponins e. CK- MB and Myoglobin Compared With Troponin e. Immediate Management e. Discharge From the ED or Chest Pain Unit: Recommendations e. Early Hospital Care e. Standard Medical Therapies e. Oxygen: Recommendation e. Anti- Ischemic and Analgesic Medications e. Nitrates: Recommendations e. Analgesic Therapy: Recommendations e. Beta- Adrenergic Blockers: Recommendations e. Calcium Channel Blockers: Recommendations e. Other Anti- Ischemic Interventions e. Cholesterol Management e. Inhibitors of the Renin- Angiotensin- Aldosterone System: Recommendations e. Initial Antiplatelet/Anticoagulant Therapy in Patients With Definite or Likely NSTE- ACS e. Initial Oral and Intravenous Antiplatelet Therapy in Patients With Definite or Likely NSTE- ACS Treated With an Initial Invasive or Ischemia- Guided Strategy: Recommendations e. Aspirin e. 36. 54. P2. Y1. 2 Receptor Inhibitors e. Initial Parenteral Anticoagulant Therapy in Patients With Definite NSTE- ACS: Recommendations e. Low- Molecular- Weight Heparin e. Bivalirudin e. 36. Fondaparinux e. 36. Unfractionated Heparin e. Argatroban e. 36. Fibrinolytic Therapy in Patients With Definite NSTE- ACS: Recommendation e. Ischemia- Guided Strategy Versus Early Invasive Strategies e. General Principles e. Rationale and Timing for Early Invasive Strategy e. Routine Invasive Strategy Timing e. Rationale for Ischemia- Guided Strategy e. Early Invasive and Ischemia- Guided Strategies: Recommendations e. Comparison of Early Versus Delayed Angiography e. Subgroups: Early Invasive Strategy Versus Ischemia- Guided Strategy e. Care Objectives e. Risk Stratification Before Discharge for Patients With an Ischemia- Guided Strategy of NSTE- ACS: Recommendations e. Noninvasive Test Selection e. Selection for Coronary Angiography e. Myocardial Revascularization e. Percutaneous Coronary Intervention e. PCI–General Considerations: Recommendation e. PCI–Antiplatelet and Anticoagulant Therapy e. Oral and Intravenous Antiplatelet Agents: Recommendations e. GP IIb/IIIa Inhibitors: Recommendations e. Anticoagulant Therapy in Patients Undergoing PCI: Recommendations e. Timing of Urgent CABG in Patients With NSTE- ACS in Relation to Use of Antiplatelet Agents: Recommendations e. Late Hospital Care, Hospital Discharge, and Posthospital Discharge Care e. General Principles (Cardioprotective Therapy and Symptom Management) e. Medical Regimen and Use of Medications at Discharge: Recommendations e. Late Hospital and Posthospital Oral Antiplatelet Therapy: Recommendations e. Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE- ACS e. Platelet Function and Genetic Phenotype Testing e. Risk Reduction Strategies for Secondary Prevention e. Cardiac Rehabilitation and Physical Activity: Recommendation e. Patient Education: Recommendations e. Pneumococcal Pneumonia: Recommendation e. NSAIDs: Recommendations e. Hormone Therapy: Recommendation e. Antioxidant Vitamins and Folic Acid: Recommendations e. Plan of Care for Patients With NSTE- ACS: Recommendations e. Systems to Promote Care Coordination e. Special Patient Groups e. NSTE- ACS in Older Patients: Recommendations e. HF: Recommendations e. Arrhythmias e. 38. Cardiogenic Shock: Recommendation e. Diabetes Mellitus: Recommendation e. Adjunctive Therapy e. Post–CABG: Recommendation e. Perioperative NSTE- ACS Related to Noncardiac Surgery: Recommendations e. CKD: Recommendations e. Antiplatelet Therapy e. Women: Recommendations e. Anemia, Bleeding, and Transfusion: Recommendations e. Thrombocytopenia e. Cocaine and Methamphetamine Users: Recommendations e. Vasospastic (Prinzmetal) Angina: Recommendations e. ACS With Angiographically Normal Coronary Arteries: Recommendation e. Stress (Takotsubo) Cardiomyopathy: Recommendations e. Obesity e. 39. 37. Patients Taking Antineoplastic/Immunosuppressive Therapy e. Quality of Care and Outcomes for ACS–Use of Performance Measures and Registries e. Use of Performance Measures and Registries: Recommendation e. Summary and Evidence Gaps e. References e. 39. Appendix 1. Author Relationships With Industry and Other Entities (Relevant) e. Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant) e. Appendix 3. Abbreviations e. Appendix 4. Additional Tables e. Preamble. The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients. Since 1. 98. 0, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health. These CPGs, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to published reports from the Institute of Medicine. ACC/AHA’s mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Practice Guidelines (Task Force) began modifying its methodology. This modernization effort is published in the 2. Methodology Summit Report. The latter recounts the history of the collaboration, changes over time, current policies, and planned initiatives to meet the needs of an evolving healthcare environment. Recommendations on value in proportion to resource utilization will be incorporated as high- quality comparative- effectiveness data become available. The relationships between CPGs and data standards, appropriate use criteria, and performance measures are addressed elsewhere. Intended Use–CPGs provide recommendations applicable to patients with or at risk of developing cardiovascular disease. The focus is on medical practice in the United States, but CPGs developed in collaboration with other organizations may have a broader target. Although CPGs may be used to inform regulatory or payer decisions, the intent is to improve the quality of care and be aligned with the patient’s best interest. Evidence Review–Guideline writing committee (GWC) members are charged with reviewing the literature; weighing the strength and quality of evidence for or against particular tests, treatments, or procedures; and estimating expected health outcomes when data exist. In analyzing the data and developing CPGs, the GWC uses evidence- based methodologies developed by the Task Force. A key component of the ACC/AHA CPG methodology is the development of recommendations on the basis of all available evidence. Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only selected references are cited in the CPG. To ensure that CPGs remain current, new data are reviewed biannually by the GWCs and the Task Force to determine if recommendations should be updated or modified. In general, a target cycle of 5 years is planned for full revisions. Guideline- Directed Medical Therapy–Recognizing advances in medical therapy across the spectrum of cardiovascular diseases, the Task Force designated the term “guideline- directed medical therapy” (GDMT) to represent recommended medical therapy as defined mainly by Class I measures, generally a combination of lifestyle modification and drug- and device- based therapeutics.
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