The Living Guidelines: UA/NSTEMI Recommendations for UA/NSTEMI in Diabetic Patients Polling Results for CLASS I Guidelines

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Class I Guidelines

1. Medical treatment in the acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus. (Level of Evidence: A) [1] [2]

<Poll> UA/NSTEMI Guidelines Class I Recommendation 1 for UA/NSTEMI in Diabetic Patients should be: CLASS I CLASS IIa CLASS IIb CLASS III </poll>

2. In all patients with diabetes mellitus and UA/NSTEMI, attention should be directed toward aggressive glycemic management in accordance with current standards of diabetes care endorsed by the American Diabetes Association and the American College of Endocrinology.

Goals of therapy should include a pre-prandial glucose target of <110 mg/dL and a maximum daily target of <180 mg/dL. The post discharge goal of therapy should be HbA1C <7%, which should be addressed by primary care and cardiac caregivers at every visit. (Level of Evidence: B) [1] [2]

<Poll> UA/NSTEMI Guidelines Class I Recommendation 2 for UA/NSTEMI in Diabetic Patients should be: CLASS I CLASS IIa CLASS IIb CLASS III </poll>

3. An intravenous platelet GP IIb/IIIa inhibitor should be administered for patients with diabetes mellitus as recommended for all UA/NSTEMI patients. (Level of Evidence: A) [1] [2]

<Poll> UA/NSTEMI Guidelines Class I Recommendation 3 for UA/NSTEMI in Diabetic Patients should be: CLASS I CLASS IIa CLASS IIb CLASS III </poll>

a. This benefit may be enhanced in patients with diabetes mellitus. (Level of Evidence: B) [1] [2]


<Poll> UA/NSTEMI Guidelines Class I Recommendation 3a for UA/NSTEMI in Diabetic Patients should be: CLASS I CLASS IIa CLASS IIb CLASS III </poll>

References

  1. 1.0 1.1 1.2 1.3 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. 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). Circulation 2007 116: e148 – e304. PMID 17679616
  2. 2.0 2.1 2.2 2.3 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. Correction of 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). J Am Coll Cardiol. 2008 Mar 4; 51(9): 974. PMID 17692738



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