Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a focused update to the 2007 guidelines for the management of patients with unstable angina (UA)/non-ST-elevation myocardial infarction (non-STEMI). Yesterday, at the ACC’s Annual Scientific Session in New Orleans, the lead author of the update, R. Scott Wright, MD, professor of medicine and consultant in cardiology and acute coronary care at the Mayo Clinic, discussed the evidence behind the updates.
According to the guideline writing committee, several major advances have occurred in the treatment of patients with UA/non-STEMI over the past 3 years:
•Recent study results have better clarified the timing of acute interventional therapy in this setting. In all but the highest-risk patients, immediate catheterization and intervention does not offer a benefit over initial medical stabilization followed by early catheterization and intervention.
•The timing, duration, and application of dual antiplatelet therapy and triple antiplatelet therapy have been elucidated; further evidence supports the role of triple antiplatelet therapy in high-risk patients and dual antiplatelet therapy in all other patients. In addition, a thienopyridine can be used as one of the agents in dual antiplatelet therapy.
•The role and potential benefit of invasive therapies in patients with advanced renal dysfunction has been further clarified.
The 2007 guidelines recommended initial noninvasive preliminary tests as well as the use of clopidogrel(Drug information on clopidogrel) for at least 1 year after placement of a drug-eluting stent; highlighted the importance of blood pressure control; and advised cessation of NSAID use for all UA/non-STEMI patients during hospitalization.
The 2011 focused update also further incorporates the risk-score risk analysis into clinical decision-making; platelet function and platelet genotype testing; the duration of thienopyridine therapy in patients treated with drug-eluting stents; and the evaluation of renal function before use of contrast agents with diagnostic angiography.
The 2011 focused update will be published in the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association, and will be posted ahead of print on the ACC and AHA web sites.
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