The Living Guidelines: UA/NSTEMI Recommendations for Anti Ischemic Therapy Polling Results for CLASS III Guidelines

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Class III Guidelines
1. Nitrates should not be administered to UA/NSTEMI patients with systolic blood pressure <90mmHg or ≥30 mmHg below baseline, severe bradycardia (<50 bpm), tachycardia (>100 bpm) in the absence of symptomatic Heart Failure, or right ventricular infarction. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class III Recommendation 1 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III

2. Nitroglycerin or other nitrates should not be administered to patients with UA/NSTEMI who had received a phosphodiesterase inhibitor for erectile dysfunction within 24 h of sildenafil or 48 h of tadalafil use. The suitable time for the administration of nitrates after vardenafil has not been determined. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class III Recommendation 2 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III

3. Immediate-release dihydropyridine calcium antagonists should not be administered to patients with UA/NSTEMI in the absence of a beta blocker. (Level of Evidence: A)

 UA/NSTEMI Guidelines Class III Recommendation 3 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III

4. An intravenous ACE inhibitor should not be given to patients within the first 24 h of UA/NSTEMI because of the increased risk of hypotension. (A possible exception may be patients with refractory hypertension.) (Level of Evidence: B)

 UA/NSTEMI Guidelines Class III Recommendation 4 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III

5. It may be harmful to administer intravenous beta blockers to UA/NSTEMI patients who have contraindications to beta blockade, signs of HF or low-output state, or other risk factors for cardiogenic shock. (Level of Evidence: A)

 UA/NSTEMI Guidelines Class III Recommendation 5 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III

6. Non steroidal anti-inflammatory drugs (except for ASA), whether non selective or COX-2–selective agents, should not be administered during hospitalization for UA/NSTEMI because of the increased risks of mortality, reinfarction, hypertension, Heart Failure, and myocardial rupture associated with their use. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class III Recommendation 6 for Anti Ischemic Therapy should be: CLASS I CLASS IIa CLASS IIb CLASS III