TABLE 10-4 - Summary of the current ACC/AHA guideline recommendations for medical management of acute coronary syndromes (ACS) and acute myocardial infarction (AMI)
| Medication | Acute Therapies ACS | Acute Therapies AMI | Discharge Therapies |
| Aspirin (ASA) | IA | IA | IA |
| Clopidogrel in ASA-allergic patients | IA | IC | IA |
| Clopidogrel, intended medical management | IA | - | IA |
| Clopidogrel, early catheterization/percutaneous coronary intervention (cath/PCI) | IA (prior to or at time of PCI) | IB | IA |
| Heparin (unfractionated heparin or low-molecular-weight heparin) | IA | IA2 | - |
| ß-Blockers | IB | IA | IB |
| ACE inhibitors | IB3 | IA/IIaB4 | IA |
| Glycoprotein (GP) IIb/IIIa inhibitors for intended early cath/PCI | |||
| Eptifibatide/tirofiban | IA | - | - |
| Abciximab | IA | IIaB5 | - |
| GP IIb/IIIa inhibitors for high-risk patients without intended early cath/PCI | |||
| Eptifibatide/tirofiban | IIaA | - | - |
| Abciximab | IIIA | - | - |
| Lipid-lowering agent6 | - | - | IA |
| Smoking cessation counseling | - | - | IB |
1 Class I indicates treatment is useful and effective, IIa indicates weight of evidence is in favor of usefulness/efficacy, class IIb indicates weight of evidence is less well established, and class II indicates intervention is not useful/effective and may be harmful. Type A recommendations are derived from large-scale randomized trials, and B recommendations are derived from smaller randomized trials or carefully conducted observational analyses. ACC/AHA = American College of Cardiology/American Heart Association.
2 As a class IIb, low-molecular-weight heparin (best studied is enoxaparin with tenecteplase) can be considered an acceptable alternative to unfractionated heparin for patients less than 75 years old who are receiving fibrinolytic therapy provided significant renal dysfunction is not present.
3 For patients with persistent hypertension despite treatment, diabetes mellitus, congestive heart failure, or any left ventricular dysfunction. ACE = angiotensin-converting enzyme.
4 IA for patients with congestive heart failure or ejection fraction < 0.40, IIa for others, in absence of hypotension (systolic blood pressure < 100 mm Hg); angiotensin receptor blocker (valsartan or candesartan) for patients with ACE inhibitor intolerance.
5 As early as possible before primary PCI.
6 For patients with a low-density lipoprotein cholesterol level > 100 mg/dL.