The Living Guidelines: UA/NSTEMI Recommendations for UA/NSTEMI in patients with Cardiovascular Syndrome X Polling Results for CLASS IIb 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.

Class IIb Guidelines
1. Intracoronary ultrasound to assess the extent of atherosclerosis and rule out missed obstructive lesions may be considered in patients with syndrome X. (Level of Evidence: B)

 UA/NSTEMI Guidelines Class IIb Recommendation 1 for UA/NSTEMI in patients with Cardiovascular Syndrome X should be: CLASS I CLASS IIa CLASS IIb CLASS III

2. If no ECGs during chest pain are available and coronary spasm cannot be ruled out, coronary angiography and provocative testing with acetylcholine, adenosine, or methacholine and 24 h ambulatory ECG may be considered. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class IIb Recommendation 2 for UA/NSTEMI in patients with Cardiovascular Syndrome X should be: CLASS I CLASS IIa CLASS IIb CLASS III

3. If coronary angiography is performed and does not reveal a cause of chest discomfort, and if syndrome X is suspected, invasive physiological assessment (i.e., coronary flow reserve measurement) may be considered. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class IIb Recommendation 3 for UA/NSTEMI in patients with Cardiovascular Syndrome X should be: CLASS I CLASS IIa CLASS IIb CLASS III

4. Imipramine or aminophylline may be considered in patients with syndrome X for continued pain despite implementation of Class I measures. (Level of Evidence: C)

 UA/NSTEMI Guidelines Class IIb Recommendation 4 for UA/NSTEMI in patients with Cardiovascular Syndrome X should be: CLASS I CLASS IIa CLASS IIb CLASS III

5. Transcutaneous electrical nerve stimulation and spinal cord stimulation for continued pain despite the implementation of Class I measures may be considered for patients with syndrome X. (Level of Evidence: B)

 UA/NSTEMI Guidelines Class IIb Recommendation 5 for UA/NSTEMI in patients with Cardiovascular Syndrome X should be: CLASS I CLASS IIa CLASS IIb CLASS III

Reference

 * Anderson JL, Adams CD, Antman EM et. al, ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction). Circulation published online Aug 6, 2007; DOI: 10.1161/CIRCULATION AHA.107.181940