The Living Guidelines: Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI Polling Results for CLASS I Guidelines

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Class I
1. An early invasive PCI strategy is indicated for patients with UA / NSTEMI who have no serious comorbidity and who have coronary lesions amenable to PCI and who have characteristics for invasive therapy (Class I Level of Evidence: A)

a. Apply Invasive therapy if;
1a.1. Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines: Class I Recommendation 1a.1 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be; CLASS I CLASS IIa CLASS IIb CLASS III 1a.2. Elevated cardiac biomarkers (cTnT or cTnI) (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.2 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.3. New or presumably new ST-segment depression (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.3 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.4. Signs or symptoms of heart failure HF or new or worsening mitral regurgitation (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.4 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.5. High-risk findings from noninvasive testing (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.5 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.6. Hemodynamic instability (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.6 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.7. Sustained ventricular tachycardia (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.7 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.8. PCI within 6 months (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.8 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.9. Prior CABG (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a. for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.10. High-risk score (e.g., TIMI risk score, GRACE risk score) (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.10 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III 1a.11. Reduced Left Ventricular function (LVEF less than 40%) (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1a.11 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III

b. Apply Conservative Therapy if;
1b.1. Low-risk score (e.g., TIMI risk score, GRACE risk score) (Class I Level of Evidence: A), Patient or physician preference in absence of high-risk features (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1b.1 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III

1b.2. Percutaneous coronary intervention (or CABG) is recommended for UA / NSTEMI patients with 1-or 2-vessel CAD with or without significant proximal left anterior descending CAD but with a large area of viable myocardium and high-risk criteria on noninvasive testing. (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1b.2 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III

1b.3. Percutaneous coronary intervention (or CABG) is recommended for UA / NSTEMI patients with multi vessel coronary disease with suitable coronary anatomy, with normal LV function, and without diabetes mellitus. (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1b.3 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III

1b.4. An intravenous Glycoprotein IIb/IIIa inhibitor is useful in UA / NSTEMI patients undergoing PCI. (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1b.4 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III

1b.5. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in UA / NSTEMI patients who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures). (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 1b.5 for Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI should be CLASS I CLASS IIa CLASS IIb CLASS III