AHA NSTE-ACS Guidelines - Free

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

• 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