Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 105.Grines CL, Bonow RO, Casey Jr DE et al. Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents. A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians. J Am Coll Cardiol 2007; 49 : 734-739. 106.Lopez-Sendon J, Swedberg K, McMurray Jet al. Expert consensus document on beta-andrenergic receptor blockers. Eur Heart J 2004; 25 : 1341-1362 107.Dargie HJ. Effects of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction; the CAPRICORN randomized trial. Lancet 2001; 357 : 1385-90 108.Ellis K, Tcheng JE, Sapp S et al. Mortality benefit of beta blockade in patients with acute coronary syndromes undergoing intervention; pool results from the Epic, Epilog, Epistent, Capture and Rapport Trials. J. Interv Cardiol 2003; 16 : 299-305 109.MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360 : 7-22. 110.Briel M, Schwartz GG, Thompson PL, et al. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials. JAMA 2006; 295 : 2046-56 111.Hulten E, Jackson JL, Douglas K et al. The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166 : 1814-1821 112.De Backer G, Ambrosioni E, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention on clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2003; 24 : 1601-1610 113.Smith SC Jr, Allen J, Blair SN et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease 2006 update: endorsed by the National Heart, lung, and Blood Institute. Circulation 2006; 113 : 2363-2372 114.Ridker PM, Cannon CP, Morrow D et al C Reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352 : 20-28 115.Chapman MJ, Assmann G, Fruchant JC et al. Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid-a position paper developed by the European Consensus Panel on HDL-C. Curr Med Res Opin 2004; 20 : 1253-1268 116.Rubins HB, Robins SJ. Collins D et al. Gemfibrazil for the secondary prevention of coronary heart disease in men with low level of high density lipoprotein cholesterol. Veteran Affairs HDL cholesterol intervention (VA-HIT) Study Group. N Eng J.Med 1993; 341 : 410-418 117.The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342 : 821-828 118.Pfeffer MA, Braunwald E, Moye LA et al. on behalf of the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 1992; 327 : 669-677 119.Torp-Pedersen C, Kober L. Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation. Lancet 1999; 354 : 9-12 120.Braunwald E, Domanski MJ, Fowler SE et al. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351 : 2058-2068 51 49
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 121.Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double blind, placebo- controlled, multicentre trial (the EUROPA study). Lancet 2003; 362 : 782-788 122.Yusuf S, Sleight P, Pogue J et al. Effects on an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342 : 145-153 123.Dagenais GR, Pogue J, Fox K et al. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet 2006; 368 : 581-588 124.Danchin N, Cucherat M, Thuillez C et al. Angiotensin-converting-enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized controlled trials. Arch Intern Med 2006; 166 : 787-796 125.Fox K, Ferrari R, Yusuf S, Borer JS. Should angiotensin-converting-enzyme- inhibitors be used to improved outcome in patients with coronary artery disease and ‘preserved’ left ventricular function? Eur Heart J 2006; 27 : 2154-2157 126.Pitt B. ACE inhibitors for patients with vascular disease without left ventricular dysfunction-may they rest in PEACE? N Engl J Med 2004; 351: 2115-7 127.Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomized trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antogonist Losartan. Lancet 2002; 360 : 752-760 128.Pfeffer MA, McMurray JJ, Velazquez EJ et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003; 349 : 1893-1906 129.Effect of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial: The Telmisartan Randomized Assessment Study in ACE intolerant subjects with cardiovascular Disease (TRANSCEND) Investigators. Lancet 2008; 372 : 1174-1183. 130.Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341: 709-717 131.Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348 : 1309-1321 132.Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarctionCombined experience of randomized clinical trials. JAMA 1988; 260 : 945-950. 133.O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80 : 234- 244. 134.McAlister FA, Lawson FM, Teo KK, Armstrong PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review Br Med J 2001; 323 : 957-962 135.Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with coronary artery disease Ann Intern Med 2005; 143 : 659-672 52 50
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 APPENDIX I: Braunwald’s Classification of Unstable Angina* CLINICAL CIRCUMSTANCES AB C Severity Develops in Develops in Develops Presence of Absence of Within 2 weeks Extracardiac Extracardiac of MI Condition That Condition (Primary (Postinfarction Intensifies UA) UA) Myocardial Ischemia (Secondary UA) I—New onset of IA IB IC severe angina or accelerated angina; no rest pain II—Angina at rest IIA IIB IIC within past month but not within preceding 48 hours (angina at rest, subacute) III—Angina at rest IIIA IIIB-Tneg IIIB-Tpos IIIC within 48 hours (angina at rest, acute) UA : Unstable angina; T : Troponins *Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000 ;102 :118-22. 53 51
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 AppAepnpdenixdiIxI:II:ElEelveavtaitoionnssooffccaardiaaccttrrooppoonnininininthtehaebasbensecencoef of oovveerrtt iisschaaeemmiicchheeaartrdt idsiesaesaes*e* DamDaagmeargeelareteladtetdotsoesceocnodnadrayrymmyyooccaarrddiiaall iisscchhaaeemmiaia(M(MI tIytpyep2e) 2) THAaoycprthTHAAoicyaocy--ucprdothtooiiercsy-rhs-adobeyonirsrpcrdahstebeydicorrpchyatnteeradioornraytnnresanhinciradoyrsnhhtnisdhoye,etnmashev,remi.teeagvfi.resaa.geris.hleuaharaoaeeoermwtrmitcioictohrvrvrorahahulalavtvggeesiiiccgddnisisssihfeheiocaoaacscsknek,et,hchyopynpecreotmertneitsanivnsetivceeomreoemnrgaeeryrngcaeyrntecryy Acudtieseaansde c(ChAroDn)ic heart failure without significant concomitant coronary artery diseaHsyepe(rCtrAopDh)ic cardiomyopathy HypCeortrroonpahriycvcaasrcduiloitims,yeo.pg.asthysytemic lupus erythematosus, Kawasaki syndrome CoroCnoarorynavraysecnudloittihse, leia.lgd. yssyfsutnecmtioicn wluipthuosutesryigtnhieficmaanttoCsAuDs,, Ke.agw. caoscaakini esyanbdursoeme Coronary endothelial dysfunction without significant CAD, e.g. cocaine abuse Damage not related to myocardial ischaemia Damage not related to myocardial ischaemia Cardiac contusion CardCiaarcdicaocnintucsisiioonns with surgery CardRiaadcioinfrceiqsuioennscywoirthcrsyuoragbelarytion therapy RadRiohfarebqduomenycoylysoirs cwriythoacabrladitaiocnintvhoelvraepmyent RMChayarodSCMbcieaaodyvrortodoedcmirxaioetiirtycsodboxiautliiycsrgsneaissngaetwsfnf,eittsche,t.iecgna.g.gra.>dna3iatn0hct%hrairnaocvcfyoybcclolvilnidenyeemssse,,unhhrfteearcrcceeepptitnin, ,cacarbrobnonmomnoonxoidxeidpeoipsoonisinogning SeInvdeereterbmurinnasnatfofercmtinuglti>fa3c0to%riaolf gbrooduypsurface IndeteArpmicianlabnatllooornmingulstyifnadcrotomreial group Severe pulmonary embolism or pulmonary hypertension ApicPaelrbipaalrlotuomnicnagrdsioymndyroopmatehy SevRereenaplufalmiluorneary embolism or pulmonary hypertension PeriSpeavreturemaccaurtedinoemuyroolopgaitchayl diseases, e.g. stroke, trauma RenIanlfilftarailtuivree diseases, e.g. amyloidosis, sarcoidosis SevEerxetreamcueteexneertuiornological diseases, e.g. stroke, trauma InfiltSraetpivseis diseases, e.g. amyloidosis, sarcoidosis ExtrAecmueteerexseprtirioantory failure SepFsrisequent defibrillator shocks Acute respiratory failure Fr*WeTqohruykgeinengsteGndreKofu,ipbMroailnilraAJt,ocKuratestuhCsoaHcrdkeisat calCfoarreS.tuRdeycoGmromuepnodnatBioionms aforrkethrse in Cardiology of the ESC use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010; 31 : 2197-2204. *Thygesen K, Mair J,Katus H et al for Study G5r4oup on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010; 31 : 2197-2204. 54 52
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 AAppppeennddixixIII:I: LLiikkeelliihhoooodd TThhat Signs and SSyymmppttoommssRReepprreesseennttaannAACCSS sseecondary to CAADD GGrereaateterrLLikikeelilhihoooodd LLoowweerr LLiikkeelliihhoooodd HHisistotoryry CChheesst toorrleleftftaarrmmppaaiinnoorr ddiissccomfort as CChheessttppaaininssininththeeaabbsseenncceeoof f cchhieief fssyymmpptotommrreepprroodduucciinngg pprior aannyy oofftthheeggrreeaateterrlilkikeelilhihoooodd ddooccuummeennteteddaannggininaa cchhaarraacctteerrisistticicss KKnnoowwnnhhisistotorryyooffCCAADD,,iinncclluudding MI RReecceenntt ccooccaainineeuussee NNeewwcchheessttoorrleleffttaarrmmppaaiinn oorr discomfort aasscchhieief fssyymmpptotomm AAggeeggrereaateterrththaann7700yyeeaarrss MMaalelesseexx DDiaiabbeetetessmmeelliltiutuss EExxaammininaatitoionn TTrarannssieiennt tMMRRmmuurrmmuurr,, hhyyppootteension, CChheesstt ddiissccoommfoforrttrerepprorodduucceedd ddiaiapphhooreressisis,,ppuulmlmoonnaarryyeeddeemma, or rales bbyy ppaallppaattioionn EExxtrtaraccaardrdiaiaccvvaassccuulalarr ddiisseeaasse EECCGG NNeeww, ,oorrppreressuummaabblylynneeww,, ttrraannsient ST- TT--wwaavvee flflaattteennininggoorrininvveersrsioionn sseeggmmeennttddeevviaiatitoionn((11mmmm oorr ggreater) or T- lleessss tthhaann11mmmmininleleaaddsswwitihth wwaavveeininvveersrsioionnininmmuullttiippllee pprree-cordial ddoommiinnaannttRRwwaavveess leleaaddss NNoorrmmaall EECCGG CCaardrdiaiaccBBioiommaarrkkeerrss EElelevvaateteddccaarrddiaiaccTTnnII,,TTnnTT,, oorr CK-MB NNoorrmmaall mmaarkrkeersrs MMooddififeieddfrforommBBrraauunnwwaaldldEE,,eettaall.. UUnnstable Angina: DDiiaaggnnoossiissaannddMMaannaaggeemmeennt.t.1199944;3;-31--1- AAHHCCPPRRPPuubblilcicaatitoionnNNoo9944--00660022::11--11554. 555 53
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 APPEANPDPIEXNIVDI:X ITVIM: I TRIIMSKI RSISCKORSECOFROER FUOAR/NUSAT/ENMSITEMI TIMI TRIiMskI RSicsokreScore ATRMhleIl,r-qCoouuRTMArairghulSeIil,hnrs-qeCooeguv1uraeiM4UrguSrierhnodsegegrvR1AeteaM4UenfrltctierodetguRyrrRAert,eRarenfNveltactieanetnuRyrswtdr,ceRIrosNuoveamcanlrenahswtRidrzecIieoaszmuocatmclriiuathoaiRirrozenireazmn,ecat%niiutoatironrn,e%nt 0-1 0-1 4.7 4.7 22 8.3 8.3 33 13.2 13.2 44 19.9 19.9 55 26.2 26.2 6-7 6-7 40.9 40.9 Tadhme iTsaTIsdhMimoeIniTrs:isIsMkioIsnrc:isokresicsodreetiesrdmeinteerdmbinyetdhebysuthme osfutmheopf rtheesepnrceeseonfc7evoafri7abvlaersiaabtles at 1 poin1tpisoignitviesngfiovreneafochr eoafcthheoffotlhloewfoinllgowvainrigabvlaersia: bles: KAhUASAEyntgTltsepeeoll-veeeswaaa6oerhSAKAUAEnttssf5geeygtltnTstteampCndyeelol-32veesesswAesaopaa6oeirarnoeDnttriissf5gnrseentrttioamknguCndy(d,32lsecimsdfeAenisopaolniareevnoaeDriirccnrsrivntpolraitoaknguaoed(,nrtlerciimitdrpfeoanodiesaolneeivrranidsrcaycrfivpol7oaotca(caoesnrd>trrhdiitrtbpoaodee0eCsoaiirrnisd.osnalyyA5fe7omoosci(cmDnssd>rshdatbtem0ieeCpoa(sris.orknrlyA)f5oeoiaemoosimoDlnsfmrssranst>,miep2(sirlaErkr4y5)fooicaeoC0ohlhftmrsr%iGnsiv>,s2iel)taE4y5ocsC0rhhtym%iGivsooe)tfoksperymrr,eoomdfkiapeabrrtu,eermdteeiaasCbt)uAertDee,sC)AD, TotalTSoctaolreSc=o7rep=oi7ntpsoints LMHoiogwdheMHLRRroiaioigswstdkhekeRRRr::aiiissst><kekk5:2R::3pip-so>4<okin5i:np2ts3tpop-oin4ointisnptstoints AdaptAeddAafnprtotmemadn:froEmM,: Cohen M, Bernink PJ, et al. The TIMI risk score for unstable anginaA/nnotmn-aSnT EelMev, aCtioonheMnI: Ma ,mBetehrondinfkorPpJr,ogentosatli.caTtihoen aTnIMd Ithreisrakpesuctoicredefocirsiounnstable Smaabkaintigamn.neaJgkAiniMnMagS/A.n,Jo2An0M-M0So0ATr;ro22ew08le04v0aD:;t8A2io38,n54–MG:4iI82u:3ga.5lim–a4ne2oth.oRdPfo, r prognostication and therapeutic decision et al. Implications of upstream glycopSroatbeaintineIIb/MIIISa, inMhoibrriotiown DaAn,d Gciourgolniaanroy RarPte, ryet staeln. tinImg pliincattihoens inovfasuivpestream managgelymceonptrotoefin unIIsbt/aIIbIale inahnigbiintiao/nnonandSTcoerolenvaartyionartmeryyocastredniatilnginfainrcttihone. inAvasive compamriasonnagoefmthenet Thorfomunbsotlaybslise inanMgyinoac/anrodnialSInTfarecletiovanti(oTnIMmI)yIoIIcBartdriiaall ainndfartchteion. A Treat caonmgipnaariswointhoAf gthgeraTsthartomanbdolydseisteirnmMineyocCaorsdtiaol fInTfahrecrtaiopny (TwIiMthI)InIIvIBastirvieal oarnd the ConseTrvreaatitveaSngtriantaegwyit(hTAACgTgIrCaSst)a-Tt IManId18dteritaelr.mCinireculCaotiostn o2f00T4h;e1r0a9py: 8w7i4th-88In0v.asive or Conservative Strategy (TACTICS)-T5I6MI 18 trial. Circulation 2004; 109 : 874-880. 56 54
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 APAPPEPNEDNIXDIVX: VG:RGARCEACPEREPDRIECDTIIOCTNIOSCNOSRCEOCRAERDCAARNDD ANNODMONGORMAMOGRAM FOFROARLLALCLAUCSAEUMSEORMTOARLITTAYLFITRYOMFRDOIMSCHDAISRCGHEATROG6E TO 6 MOMNOTNHST*HS* *Eagle KA,Lim MJ,Dabbous OH et al for the Grace Investigators. A Validated Prediction Model for All Forms of Acute Coronary Syndrome.Estimating the Risk of 6-Month Postdischarge Death in an Int*eErnaagtlieonKaAl R,LeimgisMtryJ,JDAaMbAb.o2u0s0O4;H29e1t:2a7l2fo7r-2t7h3e3G. race Investigators. A Validated Prediction Model for Forms of Acute Coronary Syndrome.Estimating the Risk of 6-Month Postdischarge Death in an International Registry JAMA. 2004;291:2727-527733. 57 55
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 APPAEPNPDEIXNDVIX: VCIa: lcCualalctiuolnatOiofnCOrefaCtirneianteinCinleaCralenacreance APPENDIXAPVPI:ENCDaIlXcuVlaI:tioCnaOlcfuClarteioantinOinf eCCreleaatirnainceeClearance EstimEastiemdaGteFdRG(FmRl/m(minl/)m=in)(1=40(-1a4g0e-)axgew)exigwhet ight or o1r.2 (11.420(-1a4g0e-)age) EstimatedEGsFtiRma(mteld/mGinF)R=(m((1l/0m4.08in-1(a)04g=.8xe1)S4(x1Cxrw4[0Seµ-imCagrgho[etµl/)mLxo])wl/Loeri]g)ht1.2SC(1ro[4Srµ0mC-rao[1gµl/.emL2) o](1l/4L0]-age) SCr : SseCrru: smercurmeactirneinaetinine(0.814 x S(C0r .[8µ1m4oxl/LSC])r [µmol/LS])Cr [µmol/LSC] r [µmol/L ] SCFr :osrewFruomrmSwecConrrem:maseetuinnrlutiminmpeluycltbripeylay0tib.n8yi5n0e.85 For womenFomr uwltoipmlyenbym0u.8lt5iplSyebvyeS0rei.tv8ye5OritfyCOKfDC*KD* SEVSEERVITEYROITFYCOKFDCKD Severity OCSRfeCEvCeKARrTDitEI*yNAIOTNfIENCICNKLEDE*CALREAANRCAENCE SENVoErmNRaoITlrmYStoaEOlmVFtiEolCdRmKITDilYd OF CKD CR>6E0A>mT6IlN0/mICmNinREl/mECAinLTEINAIRNAENCCLEEARANCE NoMromdaMelroatdoteNemroairltmde al to mild >6300-m539l/0mm-5inl>9/m6m0inlm/ml/imn in MSodeeverSareteveMreoderate 30<-3509<mm3ll0//mm3mii0nnl-/m59inml/min Severe Severe <30 ml/min<30 ml/min * Na*tioNnaatlioKniadlneKyidnFeoyunFdoautinodna. tiKon/D. OKQ/DI OcQlinIiccalilnipcraalctpicraectgicueidegluinideeslinfoers cfhoroncihcronic * kNidantieokynidanlde*iKysiNedaandsteiiseoye:naaFseloevuK:anildduenaavettaiiyoolunnaF,. toiKoucn/nlDa,dsOascQtiifloaiIcnsa.cstliifoKnicni/cDa,atOiloaQnpn,Irdacaltisninctdirecaatgilsfiutcpriadrateicfoliitcnnica.eetAsiomngfo.uriAdJmcehlinKroeJidnsniceKfoyidr ncehyronic kidDnise.y2D0i0sd2.is2;ke03ida09ns2e(;s:y3u9pepd(vslisau1elp)ua:pasSltei1o:)–n:S,Se21v2ca–l6alSus2as2tif6oicna,tiocnla, ssainficdatisotnra, tifaicnadtions.trAamtificaJtionK.idAnmey J Kidney Dis.2002; 3D9is(s.2u0p0p2l ;13):9S(1s–uSpp2l216): S1–S226 APPAEPNPDEIXNDVIXI: PVrIIe:vPernetvioentoiofnCofnCtroanstrIansdtuIcnedducNeedpNhreopphartohpyathy APPENDIXAPVPIIE: NPrDeIvXeVnItIi:oPnroefvCenotniotrnasotf ICnodnutcreadstNInedpAuhCcroCeApd/EaCNStCheC/ypEhSrCopathy ACClCas/CEslSiafiCscsAaitCfiiocCna/EtiSonC ClassificaCtiloanssification ConCtroanstrAasgtenAtgent C-- oLI---snoIuLostwsomroaew---moosuLImslotsoamososilrACenaw--mmoagiromILlgosaoeanoeosalrilngatnawnmmlraetriratmvgnoooaasoetsallggtalanumleerrAtmvnnsoaagottelggsaleueernmnnatttegsents I, A I, A IIaIII,,aIBA,, BCIIaI,, BCIIaI,, A B - AusveoAimdvinnoieim-dpuahnslreevopotmholurixmnoiictmeoaaxglicevonaltgusmeenegts eg I, C I, C I, C I, C AvNoSiAdNInDSeSAp,AImhDvreSot,iftmdoorxenmitecfionparhmgreionntotsxiecgagents eg I, C NSSAalIiDnSSea,lIminnNefeuStfsIAonirIofDmunSisn,imonetformin I, C I, C I, C Saline InfuSsailoinne Infusion III,aC, BIIa, B I, C SodSiuomdiBumicaBrbicoanrabtoenate Sodium BSicoadribuomnaBteicarbonate IIa, B IIa, B AcetAyclceytysltceyinseteine IIb, BIIb, B AcetylcysAtecienteylcysteine IIb, B IIb, B 58 58 58 58 56
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 APAPPEPNEDNIDXIVXIVII:IIIP: rPerveevnetniotinonofoCf oCnotnratrsatsItnIdnudcuecdedNNepephhroroppaaththyy AGAEGNETNT COCNOCNECNETNRTARTAITOIONN DDOOSSEE/ F/ FLLOOWWRRAATTEE SoSdoiudmiumChClohrloidreid*e* 0.90%.9%sosluotluiotnion RRataeteofo1f .10.-01-.15.5mml/kl/gkg/h/hr rfofor r 3h3-h1-21h2hbebfeofroereaanndd66hh-2-244hh afateftretrhteheprporcoecdeduurereeennssuurirningg a auruinrienefloflwowrartaeteoof f115500 RmLVmRLel/VEdhel/uEFodhcuu<Foercu4<er04ra%0rta%etetoto00.5.5mml/kl/kgg/h/hr rifif BSoicBSdaoiicrudbamiorubnmoantea*t*e** Dd(+s111oe05e8Ds(1+d15dx041xo5e054eti085turdm0x40rxo5m4omtim0tursEmm0rsomlomemEeqbsEomlsl)/qieioEfeqcLbnol/fa)/qliiofcLinw5onr/falb%afiw5onr5obt%afe%n5otrae%ntraete hti3nhoth3ifemnhuuofemscrluu/siokscrlo/sgniaokno/tgfnahnrto/eatfrhrtfosrearf1fotsrtfh1frottmoehfr1mloell1p/olhkllp/rowhogkorwoge/uoche/udrechrdredbrbfdbueobfyueofrryoeafrr6oeran6erne N-Nac-etylcysteine*** 1200 mg twice daily, one day acetylcysteine*** 12b0e0fomregatnwdicoendeadilayy, oanfteerdtahye becfoonrteraasntd one day after the contrast * McCullough PA, Bertrand ME, Brinker JA, Stacul F. A meta-analysis of the renal safety of * MiscoCsumlloluagrhioPdAix,aBneorltrcaonmdpMaEre,dBrwinitkherloJwA-,oSsmtaoclualrFc.oAntmraestta-maendailay.sisJ oAfmtheCroellnaClasradfieotly. 4o8f : isos2m00o6la; r69io2d–i9x.anol compared with low-osmolar contrast media. J Am Coll Cardiol. 48: 2006; 692–9. ** Briguori C, Colombo A, Violante A et al. Standard vs double dose of N-acetylcysteine to ** Bprriegvueonrti cCo,nCtroalsotmabgoenAt ,aVssioolcainatteedAneetpharl.otSotxaincidtya.rdEuvrsHdeoaurbt lJe2d0o0s4e; 2o5f N: 2-a0c6e-t2y1lc1y.steine to pre*v*e*nTt ecpoenltraMs,t Vagaenndt earssGoiceitatMed, SnecphhwraortzofxeilcdityC. Eeut raHl.eParret vJe2n0ti0o4n; 2o5f r:a2d0io6g-2ra1p1h. ic-contrast- a**g*e1aTn8gte0e-pi–nnet1d-l8iun4Mcd.eu,dcVeradendruedcdetuirocnGtiosienitsnMirne, nrSeacnl hafwul nafucrnztifcoetnilodnbCybyaectaeactyel.ltcyPylcsryetesvtieneneint.ieo.NnNoEfnEgrnalgdlJioJMgrMeadep.dh.i2c02-c00o00n0; t;r3a34s43t3-: : 180–184. 59 59 57
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 ACKNOWLEDGMENTS ACKNOWLEDGMENTS The committee of this guideline would like to express their gratitude and Taphpereccoimatmiointtetoe thofe tfhoilslogwuinidgefloinrethweoirucldonlitkriebutotioenx:press their gratitude and appreciation to the following for their contribution: Technical Advisory Committee, Clinical Practice Guidelines, Ministry of THeecahltnhicfoarl AthdevirisvoarlyuaCbolme minpittuetea,nCdlifneiecadlbPacrakctice Guidelines, Ministry of HPaenaelthl offoer xthteerinr avlarlueavibelweeinrspuwthaondrefveieewdbeadctkhe draft PSaencreeltoafrieaxl taesrsniasltarenvcieewfreorms wsahnoorfei-vaiveewnetids the draft Secretarial assistance from sanofi-aventis DISCLOSURE STATEMENT DISCLOSURE STATEMENT The panel members have no potential conflict of interest to disclose. The panel members have no potential conflict of interest to disclose. SOURCES OF FUNDING SOURCES OF FUNDING This CPG was made possible by an unrestricted educational grant from TShainsoCfi-PAGvenwtaiss (mMa)deSdpnosBsihbdle. bTyheanfuunndriensgtribcoteddy eddiducantoiot nianlflugerannctefrtohme Scoanntoefni-tAovfetnhtisisg(uMid)elSinden. Bhd. The funding body did not influence the content of this guideline. 60 60 58
Clinical Practice Guidelines on management of Unstable Angina/Non ST Elevation Myocardial Infarction (UA/NSTEMI) 2011 59
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