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BRAUNWALD ET AL., MANAGEMENT OF PATIENTS WITH UNSTABLE ANGINA AND NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UPDATE
http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm

ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)


Committee Members
Eugene Braunwald, MD, FACC, Chair; Elliott M. Antman, MD, FACC; John W. Beasley, MD, FAAFP; Robert M. Califf, MD, FACC; Melvin D. Cheitlin, MD, FACC; Judith S. Hochman, MD, FACC; Robert H. Jones, MD, FACC; Dean Kereiakes, MD, FACC; Joel Kupersmith, MD, FACC; Thomas N. Levin, MD, FACC; Carl J. Pepine, MD, MACC; John W. Schaeffer, MD, FACC; Earl E. Smith III, MD, FACEP; David E. Steward, MD, FACP; Pierre Theroux, MD, FACC

Task Force Members
Raymond J. Gibbons, MD, FACC, Chair; Elliott M. Antman, MD, FACC, Vice Chair; Joseph S. Alpert, MD, FACC; David P. Faxon, MD, FACC; Valentin Fuster, MD, PhD, FACC; Gabriel Gregoratos, MD, FACC; Loren F. Hiratzka, MD, FACC; Alice K. Jacobs, MD, FACC; Sidney C. Smith, Jr, MD, FACC


Preamble

I. Introduction

  1. Organization of Committee and Evidence Review
  2. Purpose of These Guidelines
  3. Overview of the Acute Coronary Syndrome
    1. Definition of Terms
    2. Pathogenesis of UA/NSTEMI
    3. Presentations of UA

II. Initial Evaluation and Management

  1. Clinical Assessment
    1. ED or Outpatient Facility Presentation
    2. Questions to be Addressed at the Initial Evaluation
  2. Early Risk Stratification
    1. Estimation of the Level of Risk
    2. Rationale for Risk Stratification
    3. The History
    4. Noncardiac Causes of Exacerbation of Symptoms Secondary to Myocardial Ischemia
    5. Assessment of Risk of Death in Patients with UA/NSTEMI
    6. Tools for Risk Stratification
    7. Decision Aids that Combine Clinical Features and ECG Findings
    8. Biochemical Cardiac Markers
    9. Integration of Clinical History with Serum Marker Measurements
    10. Other Markers
  3. Immediate Management
    1. Chest Pain Units
    2. Discharge from ED or Chest Pain Unit

III. Hospital Care

  1. Anti-Ischemic Therapy
    1. General Care
    2. Use of Anti-Ischemic Drugs
  2. Antiplatelet and Anticoagulation Therapy
    1. Antiplatelet Therapy (Aspirin, Ticlopidine, Clopidogrel)
    2. Anticoagulants
    3. Platelet GP IIb/IIIa Receptor Antagonists
  3. Risk Stratification
    1. Care Objectives
    2. Noninvasive Test Selection
    3. Selection for Coronary Angiography
    4. Patient Counseling
  4. Early Conservative Versus Invasive Strategies
    1. General Principles
    2. Care Objectives

IV. Coronary Revascularization

  1. General Principles
  2. Percutaneous Coronary Intervention
    1. Platelet Inhibitors and Percutaneous Revascularization
  3. Surgical Revascularization
  4. Conclusions

V. Hospital Discharge and Post-Hospital Discharge Care

  1. Medical Regimen
    1. Long-Term Medical Therapy
  2. Postdischarge Follow-Up
  3. Use of Medications
  4. Risk Factor Modification
  5. Medical Record

VI. Special Groups

  1. Women
    1. Stress Testing
    2. Management
    3. Data on UA/NSTEMI
    4. Conclusions
  2. Diabetes Mellitus
    1. Coronary Revascularization
    2. Conclusions
  3. Post-CABG Patients
    1. Pathological Findings
    2. Clinical Findings and Approach
    3. Conclusions
  4. Elderly Patients
    1. Pharmacological Management
    2. Observations in UA/NSTEMI
    3. Interventions and Surgery
    4. Conclusions
  5. Cocaine
    1. Coronary Artery Spasm
    2. Treatment
  6. Variant (Prinzmetal's) Angina
    1. Clinical Picture
    2. Pathogenesis
    3. Diagnosis
    4. Treatment
    5. Prognosis
  7. Syndrome X
    1. Definition and Clinical Picture
    2. Treatment

Staff

Appendix 1

Appendix 2

References

Figures & Tables

This document was approved by the American College of Cardiology Board of Trustees in March 2002 and by the American Heart Association Science Advisory and Coordinating Committee in March 2002. When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE III, Steward DE, Theroux P. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). 2002. Available at: http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm.

This document is available on the Web sites of the ACC (www.acc.org) and the AHA (www.americanheart.org). Copies of this document (the complete guidelines) are available for $5 each by calling 800-253-4636 (US only) or writing the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. To obtain a reprint of the shorter version (summary article describing the changes to the guidelines) planned for subsequent publication in J Am Coll Cardiol and Circulation, ask for reprint No. 71-0227. To purchase additional reprints (specify version and reprint number): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or e-mail pubauth@heart.org.

 

Copyright © 2002 by the American College of Cardiology and American Heart Association, Inc.

 

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