AHA NSTE-ACS Guidelines - Free

14 Treatment Table 11. Myocardial Revascularization Recommendations COR LOE PCI—General considerations A strateg y of multivessel PCI, in contrast to culprit lesion−only PCI, may be reasonable in patients undergoing coronary revascularization as part of treatment for NSTE-ACS. IIb B PCI—Oral and intravenous antiplatelet agents Patients already taking daily ASA before PCI should take 81-325 mg non–enteric-coated ASA before PCI. I B Patients not on ASA therapy should be given non−enteric-coated ASA 325 mg as soon as possible before PCI. I B Aer PCI, ASA should be continued indefinitely at a dose of 81- 325 mg daily. I B A loading dose of a P2Y 12 receptor inhibitor should be given before the procedure in patients undergoing PCI with stenting. Options include: I A • Clopidogrel: 600 mg or • Prasugrel: a 60 mg or • Ticagrelor: b 180 mg B In patients with NSTE-ACS and high-risk features (e.g., elevated troponin) who are not adequately pretreated with clopidogrel or ticagrelor, it is useful to administer a GPI (abciximab, double-bolus eptifibatide, or high-dose bolus tirofiban) at the time of PCI. I A a Patients should receive a loading dose of prasugrel provided that they were not pretreated with another P2Y 12 receptor inhibitor. b e recommended maintenance dose of ASA to be used with ticagrelor is 81 mg daily. Table 10. Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS Recommendations COR LOE Noninvasive stress testing is recommended in low- and intermediate-risk patients who have been free of ischemia at rest or with low-level activity for a minimum of 12-24 h. I B Treadmill exercise testing is useful in patients able to exercise in whom the ECG is free of resting ST changes that may interfere with interpretation. I C Stress testing with an imaging modality should be used in patients who are able to exercise but have ST changes on resting ECG that may interfere with interpretation. In patients undergoing a low-level exercise test, an imaging modality can add prognostic information. I B Pharmacological stress testing with imaging is recommended when physical limitations preclude adequate exercise stress. I C A noninvasive imaging test is recommended to evaluate LV function in patients with definite ACS. I C

• 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