A risk-based approach to acute coronary syndromes, Part 2: NSTE-MI and UA: How to maximize the benefit of drugs and procedures, before and after discharge

Patients with acute coronary syndromes without ST-segment elevation are at variable risk for death and myocardial infarction or reinfarction, depending on clinical, ECG, and laboratory findings. Reassess risk throughout the hospital course. ST-segment depression or elevated cardiac enzyme levels indicate high risk; patients without those findings but with known or probable coronary artery disease are at moderate risk. Treat moderate- and high-risk patients with aspirin and heparin; also administer a glycoprotein IIb/IIIa inhibitor to high-risk patients. For patients with recurrent ischemia, heart failure, or arrhythmias during hospitalization, strongly consider early angiography and revascularization. At discharge, prescribe aspirin, β-blocker, and angiotensin-converting enzyme inhibitor therapy; aggressive lipid lowering with 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitors is recommended as well.