AHA NSTE-ACS Guidelines - Free

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

• Cover
• Table of Contents
• Key Points
• Diagnosis
• Treatment
• Evidence Grading
• Abbreviations and Sources
• Algorithm for Patients with NSTE-ACS
• Special Patient Groups
• Standard Medical Therapies
• Initial Anticoagulant Therapy
• Early Invasive and Ischemia Guided Strategies