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UA/NSTEMI (ACC)

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Treatment Special Groups Women ÎÎManage women with UA/NSTEMI with the same pharmacological therapy as men both in the hospital and for secondary prevention, with attention to antiplatelet and anticoagulant doses based on weight and renal function. Base doses of renally cleared medications on estimated creatinine clearance. (I-B) ÎÎRecommended indications for noninvasive testing in women with UA/NSTEMI are similar to those for men. (I-B) ÎÎFor women with high-risk features, recommendations for an invasive strategy are similar to those for men (see Table 6). (I-B) ÎÎEmploy a conservative strategy for women with low-risk features. (I-B) Post-CABG Patients ÎÎMedical treatment for UA/NSTEMI patients after CABG should follow the same guidelines as for non–post-CABG patients with UA/NSTEMI. (I-C) ÎÎBecause of the many anatomic possibilities that might be responsible for recurrent ischemia, there should be a low threshold for angiography in post-CABG patients with UA/NSTEMI. (I-C) ÎÎRepeat CABG is reasonable for UA/NSTEMI patients with multiple saphenous vein graft (SVG) stenoses, especially when there is significant stenosis of a graft that supplies the left anterior descending (LAD) coronary artery. PCI is reasonable for focal saphenous vein stenosis. (Note that an intervention on a native vessel is generally preferable to that on a vein graft that supplies the same territory, if possible.) (IIa-C) ÎÎStress testing with imaging in UA/NSTEMI post-CABG patients is reasonable. (IIa-C) Older Adults ÎÎOlder patients with UA/NSTEMI should be evaluated for appropriate acute and long-term therapeutic interventions in a manner similar to younger patients with UA/NSTEMI. (I-A) ÎÎDecisions on management of older patients with UA/NSTEMI should not be based solely on chronological age but should be patientcentered, with consideration given to general health, functional and cognitive status, comorbidities, life expectancy, and patient preferences and goals. (I-B) 42

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