The Living Guidelines: Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI Suggest Revisions to the CLASS IIb Guidelines

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Class IIb Guidelines

 * 1) In the absence of high-risk features associated with UA / NSTEMI, PCI may be considered in patients with single-vessel or multi vessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a reduced likelihood of success. (Class IIb Level of Evidence: B)
 * 2) PCI may be considered in patients with UA / NSTEMI who are undergoing medical therapy who have two or three vessel disease, significant proximal left anterior descending CAD, and treated diabetes mellitus or abnormal Left Ventricular function, with anatomy suitable for catheter-based therapy. (Class IIb Level of Evidence: B)
 * 3) In initially stabilized patients, an initially conservative (i.e., a selectively invasive) strategy may be considered as a treatment strategy for UA / NSTEMI patients (without serious comorbidities or contraindications to such procedures†) who have an elevated risk for clinical events, including those who are troponin positive. (Class IIb Level of Evidence: B) The decision to implement an initial conservative (versus initial invasive) strategy in these patients may be made by considering physician and patient preference. (Class IIb Level of Evidence: C)
 * 4) An invasive strategy may be reasonable in patients with chronic renal insufficiency. (Class IIb Level of Evidence: C)