ÎÎAttention should be given to appropriate dosing (ie, adjusted by
weight and estimated creatinine clearance) of pharmacological agents
in older patients with UA/NSTEMI, because they often have altered
pharmacokinetics (due to reduced muscle mass, renal and/or
hepatic dysfunction, and reduced volume of distribution) and
pharmacodynamics (increased risks of hypotension and bleeding).
(I-B)
ÎÎOlder UA/NSTEMI patients face increased early procedural risks with
revascularization relative to younger patients, yet the overall benefits
from invasive strategies are equivalent or perhaps greater in older
adults and are recommended. (I-B)
ÎÎConsideration should be given to patient and family preferences,
quality-of-life issues, end-of-life preferences, and sociocultural
differences in older patients with UA/NSTEMI. (I-C)
Chronic Kidney Disease
ÎÎEstimate creatinine clearance in UA/NSTEMI patients and
adjust the doses of renally cleared medications according to the
pharmacokinetics data for specific medications. (I-B)
ÎÎPatients undergoing cardiac catheterization with contrast media
should receive adequate preparatory hydration. (I-B)
ÎÎCalculation of the contrast volume/creatinine clearance ratio is
useful to predict the maximum volume of contrast media that can be
given without significantly increasing the risk of contrast-associated
nephropathy. (I-B)
ÎÎAn invasive strategy is reasonable in patients with mild (stage 2) and
moderate (stage 3) CKD. Data are insufficient on the benefit/risk of an
invasive strategy in UA/NSTEMI patients with advanced CKD (stages
4, 5). (IIa-B)
Cocaine and Methamphetamine Users
ÎÎAdminister sublingual or intravenous NTG and intravenous or oral
calcium channel blockers to patients with ST-segment elevation or
depression that accompanies ischemic chest discomfort after cocaine
use. (I-C)
ÎÎPerform immediate coronary angiography, if possible, in patients
with ischemic chest discomfort after cocaine use whose ST segments
remain elevated after NTG and calcium channel blockers. PCI is
recommended if an occlusive thrombus is detected. (I-C)
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