Open AccessManagement of patients with unstable angina / non‐ST‐elevation myocardial infarction: a critical review of the 2007 ACC /AHA guidelines
Author(s) -
Hoekstra J.,
Cohen M.
Publication year - 2009
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/j.1742-1241.2009.01998.x
Subject(s) - medicine , unstable angina , bivalirudin , clopidogrel , myocardial infarction , fondaparinux , acute coronary syndrome , intensive care medicine , cardiology , percutaneous coronary intervention , venous thromboembolism , thrombosis
Summary Background: In 2007, the American College of Cardiology/American Heart Association (ACC/AHA) published new guidelines for the diagnosis and management of patients with unstable angina/non‐ST segment elevation myocardial infarction (UA/NSTEMI). These guidelines include some important updates on the use of clopidogrel, fondaparinux, bivalirudin and low‐molecular‐weight heparins (LMWHs) all of which have published landmark clinical trials in patients with acute coronary syndromes (ACS) since the publication of the 2002 guidelines. While these 2007 guidelines are more comprehensive and up‐to‐date compared with the recommendations published in 2002, they also raise many questions for practising emergency physicians and cardiologists. Methods: This article presents a critical review of the 2007 ACC/AHA UA/NSTEMI guidelines, highlighting some of the areas of controversy, with the aim of providing some further guidance to practising physicians. Conclusions: Despite recent updates to the ACC/AHA UA/NSTEMI guidelines, additional factors need to be taken into consideration in the management of UA/NSTEMI patients. Integrating initial responses with early or selectively invasive strategies and the risks of complications in subsequent procedures require careful consideration. Protocol development within an institution is required to risk‐stratify patients rapidly, provide optimum precatheterisation medical management and allow seamless and rapid transitions to the catheterisation laboratory in patients at risk for adverse events.