ÎÎAn ACE inhibitor should be administered orally within the first 24 h
to UA/NSTEMI patients with pulmonary congestion or LV ejection
fraction (LVEF) ≤0.40, in the absence of hypotension (systolic blood
pressure <100 mm Hg or >30 mm Hg below baseline) or known
contraindications to that class of medications. (I-A)
ÎÎAn angiotensin receptor blocker (ARB) should be administered to
UA/NSTEMI patients who are intolerant of ACE inhibitors and have
either clinical or radiological signs of HF or LVEF ≤0.40. (I-A)
ÎÎBecause of the increased risks of mortality, reinfarction, hypertension,
HF, and myocardial rupture associated with their use, nonsteroidal
anti-inflammatory drugs (NSAIDs), except for ASA, whether
nonselective or cyclooxygenase (COX)-2–selective agents, should be
discontinued at the time a patient presents with UA/NSTEMI. (I-C)
ÎÎIt is reasonable to administer supplemental oxygen to all patients with
UA/NSTEMI during the first 6 h after presentation. (IIa-C)
ÎÎIn the absence of contradictions to its use, it is reasonable to
administer morphine sulfate intravenously to UA/NSTEMI patients if
there is uncontrolled ischemic chest discomfort despite NTG, provided
that additional therapy is used to manage the underlying ischemia.
(IIa-B)
ÎÎIt is reasonable to administer intravenous (IV) beta blockers at the
time of presentation for hypertension to UA/NSTEMI patients who do
not have one or more of the following: (IIa-B)
•
•
•
•
signs of HF
evidence of a low-output state
increased risk for cardiogenic shock
other relative contraindications to beta blockade (PR interval >0.24 s, secondor third-degree heart block, active asthma, or reactive airway disease).
ÎÎOral long-acting nondihydropyridine calcium channel blockers are
reasonable for use in UA/NSTEMI patients for recurrent ischemia in
the absence of contraindications after beta blockers and nitrates have
been fully used. (IIa-C)
ÎÎAn ACE inhibitor administered orally within the first 24 h of
UA/NSTEMI can be useful in patients without pulmonary congestion
or LVEF ≤0.40 in the absence of hypotension (systolic blood
pressure <100 mm Hg or >30 mm Hg below baseline) or known
contraindications to that class of medications. (IIa-B)
ÎÎIntra-aortic balloon pump (IABP) counterpulsation is reasonable in
UA/NSTEMI patients for severe ischemia that is continuing or recurs
frequently despite intensive medical therapy, for hemodynamic
instability in patients before or after coronary angiography, and for
mechanical complications of MI. (IIa-C)
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