Key Updates for Angina, NSTEMI
The American Heart Association and American College of Cardiology released an update of their guidelines for unstable angina and non-ST segment elevation myocardial infarction (NSTEMI). Here are some key aspects of the guidelines that you need to know:
A New Name
The guideline has changed names since the last comprehensive revision in 2007 and is now called the Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes (NSTE-ACS).
The change was to emphasize "the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations," the organizations explained in a statement.
No More Initial Conservative Management
Initial conservative management has been replaced with "ischemia-guided strategy" in order to "more clearly convey the physiologic rationale of this approach," explained Ezra A. Amsterdam, MD, writing committee chair, in a statement. Amsterdam is at the University of California Davis.
Emphasis on Medical Treatment
An early invasive strategy in this population for patients with significant coronary artery disease is still generally accepted, according to the guidelines. But the document highlights guideline-directed medical therapy for low-risk patients.
"Guideline-directed medical therapy has not always been optimally utilized and advances in noninvasive testing have the potential to identify patients with NSTE-ACS at low-intermediate risk to distinguish candidates for invasive versus medical therapy," Amsterdam said.
More on Discharge
The update included expanded recommendations for discharge, such as routine medication with dual antiplatelet therapy, education about symptoms, risk modification, cholesterol management, and cardiac rehabilitation referral.
The guideline is being published online in both the Journal of the American College of Cardiology and in Circulation: Journal of the American Heart Association.
The guidelines were sponsored exclusively by the AHA and ACC.
Amsterdam disclosed no relevant relationships with industry.
From the American Heart Association:
Source: www.medpagetoday.com
