AHA NSTE-ACS Guidelines - Free

24 Treatment Table 18. Special Patient Groups Recommendations COR LOE NSTE-ACS in older patients Older patients a with NSTE-ACS should be treated with GDMT, an early invasive strateg y, and revascularization as appropriate. I A Pharmacotherapy in older patients a with NSTE-ACS should be individualized and dose adjusted by weight and/or CrCl to reduce adverse events caused by age-related changes in pharmacokinetics/ dynamics, volume of distribution, comorbidities, drug interactions, and increased drug sensitivity. I A Management decisions for older patients a with NSTE-ACS should be patient centered, considering patient preferences/goals, comorbidities, functional and cognitive status, and life expectancy. I B Bivalirudin, rather than a GPI plus UFH, is reasonable in older patients a with NSTE-ACS, both initially and at PCI, given similar efficacy but less bleeding risk. IIa B It is reasonable to choose CABG over PCI in older patients a with NSTE-ACS who are appropriate candidates, particularly those with diabetes mellitus or complex 3-vessel CAD (e.g., SYNTAX score >22), with or without involvement of the proximal le anterior descending artery, to reduce cardiovascular disease events and readmission and to improve survival. IIa B HF and cardiogenic shock Patients with a history of HF and NSTE-ACS should be treated according to the same risk stratification guidelines and recommendations for patients without HF. I B Selection of a specific revascularization strateg y should be based on the degree, severity, and extent of CAD; associated cardiac lesions; the extent of LV dysfunction; and the history of prior revascularization procedures. I B Early revascularization is recommended in suitable patients with cardiogenic shock due to cardiac pump failure aer NSTE-ACS. I B Diabetes mellitus Medical treatment in the acute phase of NSTE-ACS and decisions to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus. I A Post–CABG Patients with prior CABG and NSTE-ACS should receive antiplatelet and anticoagulant therapy according to GDMT and should be strongly considered for early invasive strateg y because of their increased risk. I B a ose ≥75 years of age.

• Cover
• Table of Contents
• Key Points
• Diagnosis
• Treatment
• Evidence Grading
• Abbreviations and Sources
• Algorithm for Patients with NSTE-ACS
• Special Patient Groups
• Standard Medical Therapies
• Initial Anticoagulant Therapy
• Early Invasive and Ischemia Guided Strategies