Revised Guidelines for Unstable Angina and Non-ST-Elevation MI

Unstable AnginaThe American College of Cardiology and the American Heart Association have released revised guidelines for managing patients with unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI). UA and NSTEMI are acute manifestations of coronary artery disease.

Major changes suggest an initial non-invasive set of preliminary tests (stress test, echocardiogram, or radionuclide angiogram); antiplatelet therapy with clopidogrel drug (Plavix, Bristol-Myers Squibb/ Sanofi) for at least one year after insertion of a drug-eluting stent; more intense lipid and blood pressure control; and cessation of nonsteroidal anti-inflammatory drugs (NSAIDs) used for patients with UA/NSTEMI during hospitalization.

The 2002 guidelines had recommended an early invasive strategy (diagnostic angiography and revascularization) for treating UA/ NSTEMI. The new guidelines distinguish high-risk from low-risk patients and recommend an early invasive strategy for unstable and high-risk patients, with an initial non-invasive strategy in stabilized and low-risk patients.

(Source: American College of Cardiology/American Heart Association, August 7, 2007.)