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Revised guidelines for patients with unstable angina and non-ST-elevation myocardial infarction (NSTEMI) have been issued by the American College of Cardiology (ACC) and American Heart Association (AHA). This updates ACC/AHA guidelines published in 2002.


Among other changes, the new guidelines recommend:


* an initial set of noninvasive tests (for example, a stress test and echocardiogram) for people with these conditions who are stabilized or low risk, as determined by a set of risk scores. The 2002 guidelines recommended diagnostic angiography and revascularization for all patients.


* use of the antiplatelet drug clopidogrel for at least 1 year after a patient receives a drug-eluting stent


* more aggressive lipid and blood pressure (BP) control. Low-density lipoprotein should be lower than 100 mg/dL; BP should be lower than 140/90. Those with diabetes or chronic kidney disease should maintain BP below 130/80.


* discontinuing hormone replacement therapy in postmenopausal women


* discontinuing nonsteroidal anti-inflammatory drugs during the hospitalization of any patient with unstable angina or NSTEMI.



For more details on recommended diagnostic testing, drug therapies, and emergency department triage protocols, visit http://www.americanheart.org or http://www.acc.org.