{"id":7166,"date":"2011-03-28T16:25:32","date_gmt":"2011-03-28T20:25:32","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=7166"},"modified":"2011-07-19T17:44:29","modified_gmt":"2011-07-19T21:44:29","slug":"updated-unstable-anginanon-stemi-guidelines-released-by-acc-aha","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/03\/28\/updated-unstable-anginanon-stemi-guidelines-released-by-acc-aha\/","title":{"rendered":"Updated Unstable Angina\/Non-STEMI Guidelines Released by ACC &amp; AHA"},"content":{"rendered":"<p>The AHA and ACC have released a <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/full\/j.jacc.2011.02.009\">focused update of the 2007 guidelines  for the management of unstable angina and non-STEMI<\/a>. The guidelines  incorporate new information from recent clinical trials, and deal with  controversial topics such as the choice of antiplatelet agents, the use of platelet-function and  genetic tests with antiplatelet agents, and the timing and indication  for invasive therapy.<\/p>\n<p>The document endorses the FDA label for prasugrel that states &#8220;it is reasonable to consider selective use of prasugrel before  catheterization in subgroups of patients for whom a decision to proceed  to angiography and PCI has already been established for any reason&#8221; but  also cautions clinicians about the &#8220;potential bleeding risks from  prasugrel compared with clopidogrel.&#8221; The update also notes that another  oral antiplatelet agent, ticagrelor, has not yet been approved by the  FDA and is therefore not recommended for use but acknowledges that &#8220;it  may have a future role in patients with [unstable angina and non-STEMI].&#8221;<\/p>\n<p>The update includes a full discussion of platelet  function and  genetic testing for CYP2C19 allelles but does not  include a  recommendation for their use. Noting the absence of clinical  trials to  support platelet function tests, the update states that &#8220;the lack of  evidence does not mean lack of efficacy or potential benefit, but the  prudent physician should maintain an open yet critical mind-set about  the concept until data are available from \u22651 of the ongoing  randomized clinical trials examining this strategy.&#8221;<\/p>\n<p>Regarding the use of PPIs with  clopidogrel, the update agrees with a  recent ACC statement that &#8220;does not prohibit the use of PPI agents in  appropriate clinical settings, yet highlights the potential risks and  benefits from use of PPI agents in combination with clopidogrel.&#8221;<\/p>\n<p>An early invasive strategy within 12 to 24 hours of admission is  recommended only for initially stabilized high-risk patients. For  patients at lower risk, a delayed  invasive approach is &#8220;reasonable.&#8221;<\/p>\n<p>The document also clarifies the use of dual antiplatelet therapy  versus triple antiplatelet therapy and the role of invasive therapies in  patients with advanced renal dysfunction.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The AHA and ACC have released a focused update of the 2007 guidelines for the management of unstable angina and non-STEMI. The guidelines incorporate new information from recent clinical trials, and deal with controversial topics such as the choice of antiplatelet agents, the use of platelet-function and genetic tests with antiplatelet agents, and the timing [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[334,595,256,760,421,335,759],"class_list":["post-7166","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-clopidogrel","tag-guidelines","tag-nstemi","tag-platelet-function-tests","tag-ppis","tag-prasugrel","tag-unstable-angina"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7166","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=7166"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7166\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=7166"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=7166"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=7166"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}