Treatment
Risk Stratification Before Discharge
ÎÎNoninvasive stress testing is recommended in low-risk patients (Table
7) who have been free of ischemia at rest or with low-level activity and
free of HF for a minimum of 12-24 h. (I-C)
ÎÎNoninvasive stress testing is recommended in patients at intermediate
risk (Table 7) who have been free of ischemia at rest or with low-level
activity and free of HF for a minimum of 12-24 h. (I-C)
ÎÎChoice of stress test is based on the resting ECG, ability to perform
exercise, local expertise, and available technologies. Treadmill
exercise is useful in patients able to exercise in whom the ECG is
free of baseline ST-segment abnormalities, bundle-branch block,
LV hypertrophy, intraventricular conduction defect, paced rhythm,
preexcitation, and digoxin effect. (I-C)
ÎÎAn imaging modality should be added in patients with resting STsegment depression greater than or equal to 0.10 mV, LV hypertrophy,
bundle-branch block, intraventricular conduction defect, preexcitation,
or digoxin who are able to exercise. In patients undergoing a low-level
exercise test, an imaging modality can add sensitivity. (I-B)
ÎÎPharmacological stress testing with imaging is recommended when
physical limitations (eg, arthritis, amputation, severe peripheral
vascular disease, severe chronic obstructive pulmonary disease, or
general debility) preclude adequate exercise stress. (I-B)
ÎÎPrompt angiography without noninvasive risk stratification should be
performed for failure of stabilization with intensive medical treatment.
(I-B)
ÎÎA noninvasive test (echocardiogram or radionuclide angiogram)
is recommended to evaluate LV function in patients with definite
ACS who are not scheduled for coronary angiography and left
ventriculography. (I-B)
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