The Living Guidelines: UA/NSTEMI Recommendations for Anti Ischemic Therapy Suggest Revisions to the CLASS III Guidelines

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here. In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme be used. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.

Instructions on How to Edit the Guidelines:
 * Log in
 * Click on "Edit"
 * Type in changes to guidelines
 * Click "Save page" at the bottom of the page

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)
 * 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)
 * 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)
 * 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)
 * 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)
 * 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)