_ _ _UA NSTEMI Approach Guidelines v2

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2014 AHA/ACC GUIDELINES FOR THEMANAGEMENT OF PATIENTS WITH

NONST-ELEVATIONACUTE CORONARY SYNDROMES

Aimee Victoria B. Dalisay, M.D.


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Circulation. 201


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EPIDEMIOLOGY

Worldwide, cardiovascular disease (CVD) isestimated to be the leading cause o death and

loss o disability!ad"usted lie years.Coronary artery disease (CAD) has assumed

e#idemic #ro#ortions globally.

By $%$%

increase by almost &' in theglobal CVD burden.


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A A*D *+-M

nstable angina (A) and the closelyrelated condition non/+!segment

elevation myocardial inarction (M)(*+-M) are very commonmaniestations o this disease and areres#onsible or a##ro0imately 1.'million hos#itali2ations each year (+#o#ulation)


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CLASSIFICATION OF

RECOMMENDATIONS ANDLEVELS OF EVIDENCE


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(Adapted from CW Hamm et al: Lancet 358:1533, 2001, anMJ Dave!: Heart 83:3"1, 2000#


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*A3 -VA3A4*A*D MA*A5-M-*


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C3*CA3 A++-++M-* A*D *A3

-VA3A4*

Pati!t" #it$ "%"&'t( ACS

"$)%*( + ,i" "t,ati.( +a"( )!t$ *i*i$))( ) ACS a!( a(,")%t')"3 t) ('i( )! t$ !(), $)"&ita*iati)! a!( a""i"t i!t$ "*'ti)! ) t,at!t )&ti)!"40-4235 L* ) Ei(!'6 73


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-M-65-*C7 D-8A6M-* 46

48A-* 9AC37 86-+-*A4*

Pati!t" #it$ "%"&'t( ACS a!(

$i8$-,i" at%," "%'$ a"')!ti!%i!8 '$"t &ai!9 ",(:"&!a9 ":!')&/&,":!')&9 ),&a*&itati)!" "$)%*( + ,,,(

i(iat*: t) t$ ED a!(t,a!"&),t( +: EMS #$! aai*a+*5(Cla!! $% Level of &vdence C#


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8645*4++: -A637 6+;+6A9CA4*

8erorm ra#id determination o li


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8645*4++: -A637 6+;+6A9CA4*

U" ,i" "')," t) a"""" &,)8!)"i" i!&ati!t" #it$ NSTE-ACS(Cla!! $#

6iscation models can be useul in

management(Class IIa)Continuous monitoring with 1$!lead -C5 maybe a reasonable alternative with initial non!diagnostic -C5 in #atients at

intermediate@high ris< or AC+(Class IIb)

7NP ), NT&,)-7NP may be considered toassess ris< in #atients with sus#ected AC+

(Class IIb)


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M 6+; +C46-

A8 ; ,i" a't)," ), CAD ai*: $i"t),: )

CAD9 $:&,t!"i)!9 $:&,'$)*"t,)*ia9(ia+t"9 ), '%,,!t "),3

P,i), '),)!a,: "t!)"i" ) ; =0?

ST-"8!t (iati)! )! ECG

At *a"t 2 a!8i!a* !t" i! &,i), 24 $)%,"

U" ) a"&i,i! i! &,i), @ (a:"

E*at( ",% 'a,(ia' +i)a,,"


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M 6+; +C46-


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56AC- 6+; M4D-3


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-A637 6+; +6A9CA4*


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B4MA6;-6+: DA5*4++

Ma"%, 'a,(ia'-"&'i.' t,)&)!i! t,)&)!i! I), T3 at &,"!tati)! a!( > < $ at,":&t) )!"t i! a** &ati!t" #it$ "%"&'t(

ACS t) i(!ti: &att,! ) a*%"(Cla!! $# O+tai! a((iti)!a* t,)&)!i! **" +:)!( < $

i! &ati!t" #it$ i!itia* !),a* ",ia*t,)&)!i!" #it$ ECG '$a!8" a!(/),i!t,(iat/$i8$ ,i" '*i!i'a* at%,"(Cla!!$#

With contem#orary tro#onin assays, C;!MB andmyoglobin are not useul or diagnosis o AC+(Class III)


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CA6DAC B4MA6;-6+


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D+CA65- 964M - -D46 C-+ 8A* *

4bserve #atients with sym#toms consistentwith AC+ without ob"ective evidence omyocardial ischemia (non!ischemic initial -C5

and normal cardiac tro#onin) in a chest #ainunit or telemetry unit with serial -C5s andcardiac tro#onin at =! to ?!hour intervals (ClassIIa)

5ive low!ris< #atients who are reerred orout#atient testing daily as#irin, short!acting*5, and other medication i a##ro#riate (e.g.,beta bloc


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EARLY HOSPITALCARE


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STANDARD MEDICALTHERAPY


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M-DCA3 MA*A5-M-*


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M-DCA3 MA*A5-M-*


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M-DCA3 MA*A5-M-*


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M-DCA3 MA*A5-M-*


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A+86*


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8$71$ *B46+


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58 B@A *B46+


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8A6-*-6A3 A*C4A53A*


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&A'L $)*A+$*&A)D $+CH&M$A

-.$D&D+/'A/&-$&+


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+C-MA!5D-D +6A-57

L)#-,i" "'), 5859 TIMI 0 ), 1B9

GRACE 10B3 L)#-,i" T!-!8ati a*

&ati!t"

Pati!t ), '*i!i'ia! &,,!' i!t$ a+"!' ) $i8$-,i" at%,"


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MM-DA- *VA+V- +6A-57

(W* $ )

R,a't),: a!8i!a

Si8!" ), ":&t)" ) HF ), !# ),

#),"!i!8 it,a* ,8%,8itati)! H)(:!ai' i!"ta+i*it:

R'%,,!t a!8i!a ), i"'$ia at ,"t ),#it$ *)#-** a'tiiti" ("&iti!t!"i (i'a* t$,a&:

S%"tai!( VT ), VF


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-A637 *VA+V- +6A-57

(W* $ )

N)! ) t$ a+)9 +%t GRACE ,i""'), 140

T&),a* '$a!8 i! T!

N# ), &,"%a+*: !# ST

(&,""i)!


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D-3A7-D *VA+V- +6A-57

(W* $'!&$ )

N)! ) t$ a+) +%t (ia+t" **it%"

R!a* i!"%'i!': GFR

3 R(%'( LV ":"t)*i' %!'ti)! EF 05403

Ea,*: &)"t-i!a,'ti)! a!8i!a

PCI #it$i! < )

P,i), CA7G

GRACE ,i" "'), 10140 TIMI "'), ;2


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+6A-5-+


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*4*!A*5*A3 8A* MA*A5-M-*


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+8-CA3 8A-* 5648+


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+8-CA3 8A-* 5648+


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+8-CA3 8A-* 5648+


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+8-CA3 8A-* 5648+


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+8-CA3 8A-* 5648+


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+8-CA3 8A-* 5648+


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A*; 74


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_ _ _UA NSTEMI Approach Guidelines v2

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