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ACC/AHA publish revised management guidelines
New revisions shift emphasis to noninvasive early detection and secondary prevention.
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September 2007
The American College of Cardiology and the American Heart Association issued revisions to the official guidelines for the management of patients with unstable angina and non-ST–elevation myocardial infarction.
“New evidence from pivotal trials during the past five years has been gathered together in these guidelines to give physicians up-to-date and detailed information on which treatment options provide the best possible outcomes for their patients,” Nanette K. Wenger, MD, professor of medicine in the division of cardiology at Emory University School of Medicine, said in a press release. “This is a major educational document for health professionals, and I trust it will become part of the core teaching for medical students, residents and graduate physicians.”
Emphasis on prevention
The guidelines, last updated in 2002, were changed due in part to advances in the ability to detect unstable angina and non-STEMI. Some of the major changes to the guidelines relate to the selection of initial invasive vs. noninvasive strategies.
Initial invasive strategies are recommended for unstable and high-risk patients. An initial conservative strategy includes suggestions for noninvasive preliminary tests such as echocardiograms or radionuclide angiograms. Other area of emphasis are more intensive use of antiplatelet therapies including recommendations for clopidogrel (Plavix, Sanofi Aventis; Bristol-Myers Squibb) at least one year after receiving a drug-eluting stent, highlighting the importance of more intense lipid and BP control and advising cessation of NSAID use for all patients with unstable angina and non-STEMI during hospitalization.
“We are emphasizing the use of ACE inhibitors and prescribing aldosterone receptor blockade, a new drug category that wasn’t previously available for people with HF,” said Wenger. “High-dose antioxidant vitamin supplements, such as beta carotene, vitamin E, vitamin C and folic acid for secondary prevention, are no longer recommended because results from clinical trials have shown no benefit and possible harm.”
Cardiology Today reported on the updated guidelines for hypertension management in May after they were presented at the American Society of Hypertension 22nd Annual Meeting. The guidelines recommended the use of ACE inhibitors and beta-blockers to lower BP in patients with unstable angina and non-STEMI. The newly revised general guidelines for patients with unstable angina and non-STEMI emphasize similar recommendations.
The added focus on secondary prevention is intended to limit a patient’s recurrence of unstable angina and non-STEMI after the initial treatment for the conditions. – by Eric Raible
This updated guideline advances the information that has come out since our last set of guidelines. They added the new information on hormone replacement therapy, and they discussed the NSAID issue. There are much stronger recommendations for ACE inhibitors. ... There is another recommendation for stress testing. The clopidogrel and lipid-lowering and BP-lowering recommendations are the keys that I found here. There was much more emphasis on secondary prevention. That gets at the more long-term risks for these patients, which is critically important.
– Carl J. Pepine, MD,
Chief Medical Editor, Cardiology Today
For more information:
- Anderson J, Adams C, Antman E, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST–elevation myocardial infarction. J Am Coll Cardiol. 2007;50:e1-e157.