Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies

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Overview of Initial Conservative versus Initial Invasive Strategies in UA / NSTEMI

ACC / AHA Guidelines (DO NOT EDIT) [1]

“

Class I

1. An early invasive strategy (i.e., diagnostic coronary angiography with intent to perform percutaneous coronary revascularization or CABG) is indicated in UA / NSTEMI patients who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures). (Level of Evidence: B)

2. An early invasive strategy (i.e., diagnostic angiography with intent to perform percutaneous coronary revascularization or CABG) is indicated in initially stabilized UA / NSTEMI patients (without serious comorbidities or contraindications to such procedures) who have an elevated risk for clinical events (Level of Evidence: A)

Class IIb

1. In initially stabilized patients:

a. An initially conservative (i.e., a selectively invasive) strategy may be considered as a treatment strategy for UA / NSTEMI patients (without serious comorbidities or contraindications to such procedures) who have an elevated risk for clinical events including those who are troponin positive. (Level of Evidence: B)
b. The decision to implement an initial conservative (vs. initial invasive) strategy in these patients may be made by considering physician and patient preference. (Level of Evidence: C)

2. An invasive strategy may be reasonable in patients with chronic renal insufficiency. (Level of Evidence: C)

Class III

1. An early invasive strategy (i.e., diagnostic angiography with intent to perform coronary artery revascularization) is not recommended in patients with extensive comorbidities (e.g., liver failure or pulmonary failure, cancer), in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization. (Level of Evidence: C)

2. An early invasive strategy (i.e., diagnostic angiography with intent to perform coronary artery revascularization) is not recommended in patients with acute chest pain and a low likelihood of Acute coronary syndromes. (Level of Evidence: C)

3. An early invasive strategy (i.e., diagnostic angiography with intent to perform coronary artery revascularization) should not be performed in patients who will not consent to revascularization regardless of the findings. (Level of Evidence: C)

”

See Also

Sources

  • The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]

References

  1. ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM, et al (August 2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC 50 (7): e1–e157. PMID 17692738.
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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .

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