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) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventi

Table of Contents Preamble...e3 Introduction...e4 Organization of Committee and Evidence Review...e4 Purpose of These Guidelines...e6 Overview of the Acute Coronary Syndromes...e6 Definition of Terms...e6 Pathogenesis of UA/NSTEMI...e8 Presentations of UA and NSTEMI...e9 Management Before UA/NSTEMI and Onset of UA/NSTEMI...e9 Identification of Patients at Risk of UA/NSTEMI...e10 Interventions to Reduce Risk of UA/NSTEMI...e10 Onset of UA/NSTEMI...e11 Recognition of Symptoms by Patient...e11 Silent and Unrecognized Events...e11 Initial Evaluation and Management...e12 Clinical Assessment...e12 Emergency Department or Outpatient Facility Presentation...e16 Questions to Be Addressed at the Initial Evaluation...e16 Early Risk Stratification...e16 Estimation of the Level of Risk...e18 Rationale for Risk Stratification...e18 History...e19 Anginal Symptoms and Anginal Equivalents...e19 Demographics and History in Diagnosis and Risk Stratification...e20 Estimation of Early Risk at Presentation...e21 Electrocardiogram...e23 Physical Examination...e24 Noncardiac Causes of Symptoms and Secondary Causes of Myocardial Ischemia...e24 Cardiac Biomarkers of Necrosis and the Redefinition of AMI...e25 Creatine Kinase-MB...e25 Cardiac Troponins...e26 Clinical Use...e26 Clinical Use of Marker Change Scores...e28 Bedside Testing for Cardiac Markers...e29 Myoglobin and CK-MB Subforms Compared With Troponins...e29 Summary Comparison of Biomarkers of Necrosis: Singly and in Combination...e29 Other Markers and Multimarker Approaches...e29 Ischemia...e29 Coagulation...e30 Platelets...e30 Inflammation...e30 B-Type Natriuretic Peptides...e31 Immediate Management...e31 Chest Pain Units...e32 Discharge From ED or Chest Pain Unit...e33 Early Hospital Care...e34 Anti-Ischemic and Analgesic Therapy...e35 General Care...e38 Use of Anti-Ischemic Therapies...e39 Nitrates...e39 Morphine Sulfate...e40 Beta-Adrenergic Blockers...e41 Calcium Channel Blockers...e43 Inhibitors of the Renin-Angiotensin-Aldosterone System...e44 Other Anti-Ischemic Therapies...e44 Intra-Aortic Balloon Pump Counterpulsation...e45 Analgesic Therapy...e45 Recommendations for Antiplatelet/Anticoagulant Therapy in Patients for Whom Diagnosis of UA/NSTEMI Is Likely or Definite...e45 Antiplatelet Therapy Recommendations...e45 Anticoagulant Therapy Recommendations...e46 Additional Management Considerations for Antiplatelet and Anticoagulant Therapy...e47 Antiplatelet Agents and Trials (Aspirin, Ticlopidine, Clopidogrel)...e49