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)
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