Treatment
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)
ÎÎThe use of extended-release forms of nondihydropyridine calcium
channel blockers instead of a beta blocker may be considered in
patients with UA/NSTEMI. (IIb-B)
ÎÎImmediate-release dihydropyridine calcium channel blockers in the
presence of adequate beta blockade may be considered in patients
with UA/NSTEMI with ongoing ischemic symptoms or hypertension.
(IIb-B)
ÎÎNitrates should NOT be administered to UA/NSTEMI patients with
systolic blood pressure less than 90 mm Hg or greater than or equal to
30 mm Hg below baseline, severe bradycardia (<50 beats per minute),
tachycardia (>100 beats per minute) in the absence of symptomatic
HF, or right ventricular infarction. (III-C)
ÎÎNTG or other nitrates should NOT be administered to patients with
UA/NSTEMI who had received a phosphodiesterase inhibitor for
erectile dysfunction within 24 h of sildenafil or 48 h of tadalafil use.
The suitable time for the administration of nitrates after vardenafil has
not been determined. (III-C)
ÎÎImmediate-release dihydropyridine calcium channel blockers should
NOT be administered to patients with UA/NSTEMI in the absence of a
beta blocker. (III-A)
ÎÎAn intravenous ACE inhibitor should NOT be given to patients
within the first 24 h of UA/NSTEMI because of the increased risk of
hypotension. A possible exception may be patients with refractory
hypertension. (III-B)
ÎÎIt may be harmful to administer IV beta blockers to UA/NSTEMI
patients who have contraindications to beta blockade, signs of HF or
low-output state, or other risk factors for cardiogenic shock. (III-A)
ÎÎNSAIDs (except for ASA), whether nonselective or COX-2–selective
agents, should NOT be administered during hospitalization for UA/
NSTEMI because of the increased risks of mortality, reinfarction,
hypertension, HF, and myocardial rupture associated with their use.
(III-C)
12
