ÎÎConsider provocative testing in patients with no significant
angiographic CAD and no documentation of transient ST-segment
elevation when clinically relevant symptoms possibly explained by
coronary artery spasm are present. (IIb-C)
ÎÎProvocative testing is NOT recommended in patients with variant
angina and high-grade obstructive stenosis on coronary angiography.
(III-B)
Cardiovascular "Syndrome X"
Cardiovascular "syndrome X" refers to patients with angina or angina-like discomfort
with exercise, ST-segment depression on exercise testing, and normal or nonobstructed
coronary arteries on arteriography.
ÎÎPrescribe medical therapy with nitrates, beta blockers, and calcium
channel blockers, alone or in combination, in patients with Syndrome X.
(I-B)
ÎRisk factor reduction is recommended in patients with Syndrome X. (I-B)
Î
ÎÎConsider intracoronary ultrasound to assess the extent of
atherosclerosis and rule out missed obstructive lesions in patients
with Syndrome X. (IIb-B)
ÎÎIf no ECGs during chest pain are available and coronary spasm cannot
be ruled out, consider coronary angiography and provocative testing
with acetylcholine, adenosine, or methacholine and 24-h ambulatory
ECG. (IIb-C)
ÎÎIf coronary angiography is performed and does not reveal a cause of
chest discomfort, and if Syndrome X is suspected, consider invasive
physiological assessment (ie, coronary flow reserve measurement).
(IIb-C)
ÎÎConsider imipramine or aminophylline in patients with Syndrome X for
continued pain despite implementation of Class I measures. (IIb-C)
ÎÎConsider transcutaneous electrical nerve stimulation and spinal cord
stimulation for continued pain despite the implementation of Class I
measures for patients with Syndrome X. (IIb-B)
ÎÎMedical therapy with nitrates, beta blockers, and calcium channel
blockers for patients with noncardiac chest pain is NOT recommended.
(III-C)
Quality of Care and Outcomes for UA/NSTEMI
ÎÎIt is reasonable for clinicians and hospitals that provide care to
patients with UA/NSTEMI to participate in a standardized qualityof-care data registry designed to track and measure outcomes,
complications, and adherence to evidence-based processes of care
and quality improvement for UA/NSTEMI. (IIa-B)
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