2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

• Published in: Journal of the American College of Cardiology 2013-06, Vol.61 (23), p.e179-e347
• Main Authors: Anderson, Jeffrey L., MD, FACC, FAHA, Adams, Cynthia D., RN, PhD, FAHA, Antman, Elliott M., MD, FACC, FAHA, Bridges, Charles R., MD, ScD, FACC, FAHA, Califf, Robert M., MD, MACC, Casey, Donald E., MD, MPH, MBA, FACP, FAHA, Chavey, William E., MD, MS, Fesmire, Francis M., MD, FACEP, Hochman, Judith S., MD, FACC, FAHA, Levin, Thomas N., MD, FACC, FSCAI, Lincoff, A. Michael, MD, FACC, Peterson, Eric D., MD, MPH, FACC, FAHA, Theroux, Pierre, MD, FACC, FAHA, Wenger, Nanette K., MD, Wright, R. Scott, MD, FACC, FAHA
• Format: Article
• Language: English
• Subjects: ACCF/AHA Practice Guidelines; Angina pectoris; Anticoagulants; antiplatelet therapy; Cardiology; Cardiovascular; Coronary vessels; Drug therapy; focused update; glycoprotein IIb/IIIa inhibitors; Heart attacks; Hospitals; Internal Medicine; myocardial infarction; non–ST elevation; P2Y12 receptor inhibitor; percutaneous coronary intervention; Physicians; thienopyridines; unstable angina
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.01.014

Nanette K. Wenger, MD ACCF/AHA Task Force Members Jeffrey L. Anderson, MD, FACC, FAHA, Chair; Alice K. Jacobs, MD, FACC, FAHA, Immediate Past Chair; Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect; Nancy M. Albert, PhD, CCNS, CCRN; Mark A. Creager, MD, FACC, FAHA; David DeMets, PhD; Steven M. Ettinger, MD, FACC; Robert A. Guyton, MD, FACC; Judith S. Hochman, MD, FACC, FAHA; Frederick G. Kushner, MD, FACC, FAHA; E. Magnus Ohman, MD, FACC; William Stevenson, MD, FACC, FAHA; Clyde W. Yancy, MD, FACC, FAHA Table of Contents Developed in Collaboration With the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine Preamble (UPDATED)...e182 Introduction (UPDATED)...e184 Organization of Committee and Evidence Review (UPDATED)...e184 Document Review and Approval (UPDATED)...e185 Purpose of These Guidelines...e185 Overview of the Acute Coronary Syndromes...e186 Definition of Terms...e186 Pathogenesis of UA/NSTEMI...e186 Presentations of UA and NSTEMI...e189 Management Before UA/NSTEMI and Onset of UA/NSTEMI...e189 Identification of Patients at Risk of UA/NSTEMI...e189 Interventions to Reduce Risk of UA/NSTEMI...e190 Onset of UA/NSTEMI...e191 Recognition of Symptoms by Patient...e191 Silent and Unrecognized Events...e191 Initial Evaluation and Management...e191 Clinical Assessment...e191 Emergency Department or Outpatient Facility Presentation...e195 Questions to Be Addressed at the Initial Evaluation...e196 Early Risk Stratification...e196 Estimation of the Level of Risk...e198 Rationale for Risk Stratification...e198 History...e198 Anginal Symptoms and Anginal Equivalents...e198 Demographics and History in Diagnosis and Risk Stratification...e199 Estimation of Early Risk at Presentation...e200 Electrocardiogram...e202 Physical Examination...e203 Noncardiac Causes of Symptoms and Secondary Causes of Myocardial Ischemia...e204 Cardiac Biomarkers of Necrosis and the Redefinition of AMI...e204 Creatine Kinase-MB...e205 Cardiac Troponins...e205 Clinical Use...e205 Clinical Use of Marker Change Scores...e207 Bedside Testing for Cardiac Markers...e208 Myoglobin and CK-MB Subforms Compared With Troponins...e208 Summary Comparison of Biomarkers of Necrosis: Singly and in Combination...e208 Other Markers and Multimarker Approaches...e208 Ischemia...e208 Coagulation