9
Table 6. Standard Medical Therapies (cont'd)
Recommendations
COR LOE
Calcium channel blockers
In patients with NSTE-ACS, continuing or frequently
recurring ischemia, and a contraindication to beta blockers, a
nondihydropyridine CCB (e.g., verapamil or diltiazem) should be
given as initial therapy in the absence of clinically significant LV
dysfunction, increased risk for cardiogenic shock, PR interval >0.24
second, or second- or third-degree atrioventricular block without a
cardiac pacemaker.
I B
Oral nondihydropyridine calcium antagonists are recommended
in patients with NSTE-ACS who have recurrent ischemia in the
absence of contraindications, aer appropriate use of beta blockers
and nitrates.
I C
CCBs
a
are recommended for ischemic symptoms when beta
blockers are not successful, are contraindicated, or cause
unacceptable side effects.
I C
Long-acting CCBs and nitrates are recommended in patients with
coronary artery spasm.
I C
Immediate-release nifedipine should NOT be administered to
patients with NSTE-ACS in the absence of beta-blocker therapy.
III:
Harm
B
Cholesterol management
High-intensity statin therapy should be initiated or continued in all
patients with NSTE-ACS and no contraindications to its use.
I A
It is reasonable to obtain a fasting lipid profile in patients with
NSTE-ACS, preferably within 24 h of presentation.
IIa C
a
Short-acting dihydropyridine calcium channel antagonists should be avoided.
Table 7. Inhibitors of the Renin-Angiotensin-Aldosterone
System
Recommendations
COR LOE
ACE inhibitors should be started and continued indefinitely in all
patients with LVEF <0.40 and in those with hypertension, diabetes
mellitus, or stable CKD, unless contraindicated.
I A
Angiotensin receptor blockers are recommended in patients with
HF or MI with LVEF <0.40 who are ACE inhibitor intolerant.
I A
Aldosterone blockade is recommended in post–MI patients who
are without significant renal dysfunction (creatinine >2.5 mg/dL in
men or >2.0 mg/dL in women) or hyperkalemia (K
+
>5.0 mEq/L)
who are receiving therapeutic doses of ACE inhibitor and beta
blocker and have a LVEF ≤0.40, diabetes mellitus, or HF.
I A
Angiotensin receptor blockers are reasonable in other patients with
cardiac or other vascular disease who are ACE inhibitor intolerant.
IIa B
ACE inhibitors may be reasonable in all other patients with cardiac
or other vascular disease.
IIb B
