Unstable angina / non ST elevation myocardial infarction and perioperative NSTE-ACS related to noncardiac surgery
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Unstable angina / non ST elevation myocardial infarction and perioperative NSTE-ACS related to noncardiac surgery On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease[1]
Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT
| Class I |
| "1.Elective noncardiac surgery should be delayed 30 days after BMS implantation and optimally 6 months after DES
implantation(Level of Evidence: B-NR)" |
| "2.In patients treated with DAPT after coronary stent implantation who must undergo surgical procedures that
mandate the discontinuation of P2Y12 inhibitor therapy, it is recommended that aspirin be continued if possible and the P2Y12 platelet receptor inhibitor be restarted as soon as possible after surgery(Level of Evidence: C-EO)" |
| Class IIa |
| "1.When noncardiac surgery is required in patients currently taking a P2Y12 inhibitor, a consensus decision among treating
clinicians as to the relative risks of surgery and discontinuation or continuation of antiplatelet therapy can be useful.(Level of Evidence: C-EO)" |
| Class IIb |
| "1.Elective noncardiac surgery after DES implantation in patients for whom P2Y12 inhibitor therapy will need to be
discontinued may be considered after 3 months if the risk of further delay of surgery is greater than the expected risks of stent thrombosis(Level of Evidence: C-EO)" |
| Class III (No Benefit) |
| "1.Elective noncardiac surgery should not be performed within 30 days after BMS implantation or within 3 months
after DES implantation in patients in whom DAPT will need to be discontinued perioperatively(Level of Evidence: B-NR) " |
==2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes (DO NOT EDIT) [2]==
Recommendations for Perioperative NSTE-ACS Related to Noncardiac Surgery
| Class I |
| "1.Patients who develop NSTE-ACS following noncardiac surgery should receive GDMT as recommended for patients in the general population but with the modifications imposed by the specific noncardiac surgical procedure and the severity of NSTE-ACS (Level of Evidence: C)" |
| "2.In patients who develop NSTE-ACS after noncardiac surgery, management should be directed at the underlying cause (Level of Evidence: C)" |
- ↑ Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA; et al. (2016). "2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Thorac Cardiovasc Surg. 152 (5): 1243–1275. doi:10.1016/j.jtcvs.2016.07.044. PMID 27751237.
- ↑ Ezra A. Amsterdam, MD, FACC; Nanette K. Wenger, MD et al.2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JACC. September 2014 (ahead of print)