The AHA Guidelines and Scientific Statements Handbook

Chapter 2 Unstable Angina/Non-ST-Elevation Myocardial Infarction

Table 2.3

Medications Used for Stabilized UA/NSTEMI Patients

Anti-ischemic and antithrombotic/antiplatelet agents

Drug action

Class/level of evidence

Aspirin

Antiplatelet

I/A

Clopidogrel* or ticlopidine

Antiplatelet when ASA contraindicated

I/A

Beta blockers

Anti-ischemic

I/B

ACEI

EF

< 0.40 or HF EF

> 0.40

I/A IIa/A

Nitrates

Antianginal

I/C (for ischemia)

Calcium antagonists (short-acting dihydropyridine antagonists

should be avoided)

Antianginal

I for ischemic symptoms; symptoms when beta blockers are not successful

(B) or contraindicated, or cause unacceptable side effects (C)

Dipyridamole

Antiplatelet

III/A

Agents for Secondary Prevention and Other Indications

Risk Factor

Class/Level of Evidence

HMG-CoA reductase inhibitors

LDL cholesterol

> 100 mg/dL

IA

LDL cholesterol

> 70 mg/dL

IIa/A

Fibrates

HDL cholesterol

< 40 mg/dL

IIa/B

Niacin

HDL cholesterol

< 40 mg/dL

IIa/B

Niacin or fi brate

Triglycerides

> 200 mg/dL

IIa/B

Antidepressant

Treatment of depression

IIa/B

Treatment of hypertension

Blood pressure

> 140/90 mm Hg or

> 130/80 if kidney

disease or diabetes present

I/A

Treatment of diabetes

HbA1C

> 7%

I/B

Hormone therapy (initiation)†

Postmenopausal state

III/A

Hormone therapy (continuation)†

Postmenopausal state

III/B

COX-2 inhibitor or NSAID

Chronic pain

IIa/C, IIb/C or III/C

Vitamins C, E, beta-carotene; folic acid, B6, B12

Antioxidant effect; homocysteine lowering

III/A

* Preferred to ticlopidine.† For risk reduction of coronary artery disease.ACEI, angiotensin-converting enzyme inhibitor (Angiotensin receptor blockers are alternatives if ACEI are not tolerated); HF, h

eart failure; COX-2, cyclooxygenase 2; EF, ejection fraction; HDL, high-density lipoprotein; HMG-CoA,

hydroxymethyl glutaryl coenzyme A; LDL, low-density lipoprotein; NSAID, nonsteroidal anti-infl ammatory drug.