17
Table 12. Timing of Urgent CABG in Patients With NSTE-ACS
in Relation to Use of Antiplatelet Agents
Recommendations
COR LOE
Non–enteric-coated ASA (81-325 mg daily) should be
administered preoperatively to patients undergoing coronary artery
bypass gra (CABG).
I B
In patients referred for elective CABG, clopidogrel and ticagrelor
should be discontinued for ≥5 days before surgery
I B
and prasugrel for ≥7 days before surgery. C
In patients referred for urgent CABG, clopidogrel and ticagrelor
should be discontinued for ≥24 h to reduce major bleeding.
I B
In patients referred for CABG, short-acting intravenous GPIs
(eptifibatide or tirofiban) should be discontinued for ≥2-4 h before
surgery and abciximab for ≥12 h before to limit blood loss and
transfusion.
I B
In patients referred for urgent CABG, it may be reasonable to
perform surgery <5 days aer clopidogrel or ticagrelor has been
discontinued and <7 days aer prasugrel has been discontinued.
IIb C
Table 13. Discharge From the ED or Chest Pain Unit
Recommendations
COR LOE
It is reasonable to observe patients with symptoms consistent with
ACS without objective evidence of myocardial ischemia (nonischemic
initial ECG and normal cardiac troponin) in a chest pain unit or
telemetry unit with serial ECGs and cardiac troponin at 3- to 6-h
intervals.
IIa B
It is reasonable for patients with possible ACS who have normal
serial ECGs and cardiac troponins to have a treadmill ECG,
IIa A
stress myocardial perfusion imaging, or stress echocardiography
before discharge or within 72 h aer discharge.
B
In patients with possible ACS and a normal ECG, normal cardiac
troponins, and no history of CAD, it is reasonable to initially
perform (without serial ECGs and troponins) coronary computed
tomography angiography to assess coronary artery anatomy or
IIa A
rest myocardial perfusion imaging with a technetium-99m
radiopharmaceutical to exclude myocardial ischemia.
B
It is reasonable to give low-risk patients who are referred for
outpatient testing daily ASA, short-acting nitroglycerin, and other
medication if appropriate (e.g., beta blockers), with instructions
about activity level and clinician follow-up.
IIa C
