The Living Guidelines: Recommendations for UA/NSTEMI in Drug and Substance Abusers Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines

 * 1) Administration of sublingual or intravenous NTG and intravenous or oral calcium antagonists is recommended for patients with ST segment elevation or depression that accompanies ischemic chest discomfort after cocaine use. (Level of Evidence: C)
 * 2) Immediate coronary angiography, if possible, should be performed in patients with ischemic chest discomfort after cocaine use whose ST segments remain elevated after NTG and calcium antagonists; PCI is recommended if occlusive thrombus is detected. (Level of Evidence: C)
 * 3) Fibrinolytic therapy is useful in patients with ischemic chest discomfort after cocaine use if ST segments remain elevated despite NTG and calcium antagonists, if there are no contraindications, and if coronary angiography is not possible. (Level of Evidence: C)