Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The ACTION score calculator estimates the risk of ICU admission for patients with NSTEMI (Non-ST Elevation Myocardial Infarction) by considering a range of medical factors. It evaluates responses to nine specific health criteria, with each response having a predefined score. The sum of these scores reflects the patient's risk of developing complications necessitating ICU care.

Here's how the scoring for each criterion works:

- Age: 
  - < 70 years = 0
  - >= 70 years = 1

- Serum creatinine:
  - < 1.1 mg/dL = 0
  - >= 1.1 mg/dL = 1

- Heart rate:
  - < 85 BPM = 0
  - 85-100 BPM = 1
  - >= 100 BPM = 3 

- Systolic blood pressure:
  - >= 145 mmHg = 0
  - 125-145 mmHg = 1
  - < 125 mmHg = 3

- Ratio of initial troponin to the upper limit of normal:
  - < 12 = 0
  - >= 12 = 2

- Signs or symptoms of heart failure:
  - Yes = 5
  - No = 0

- ST segment depression on ECG:
  - Yes = 1
  - No = 0

- Prior revascularization:
  - Yes = 0
  - No = 1

- Chronic lung disease:
  - Yes = 2
  - No = 0

Once each of these factors is assessed and its respective score is assigned, a total score is computed by adding together all individual scores. This total score is then interpreted to indicate the likelihood of needing ICU care due to complications. The interpretation corresponds to various risk levels as follows:

- Scores less than or equal to 1 indicate a 3.4% risk.
- A score of 2 implies a 4.9% risk.
- A score of 3 translates to a 5.5% risk.
- With a score of 4, the risk is 6.9%.
- A score of 5 suggests a 9.3% risk.
- A score of 6 results in a 12% risk.
- For a score of 7, the risk increases to 14.6%.
- A score of 8 corresponds to a 17.4% risk.
- A score of 9 is associated with a 20.8% risk.
- With a score of 10, the risk rises to 23.3%.
- A score of 11 corresponds to a 27.7% risk.
- A score of 12 implies a 31% risk.
- Scores of 13 and 14 suggest risks of 31.5% and 39.3%, respectively.
- Scores above 14 indicate a risk exceeding 39.3%.

This method offers a systematic way to evaluate a patient's condition and predict the potential need for intensive care based on their health profile.

The ACTION (Acute Coronary Treatment and Intervention Outcomes Network) score is a clinical calculator used to predict the risk of Intensive Care Unit (ICU) admission in patients with Non-ST-segment Elevation Myocardial Infarction (NSTEMI). This scoring system is applicable to patients diagnosed with NSTEMI, a type of heart attack that does not cause a classic EKG change known as ST elevation. 

The ACTION score is clinically useful in stratifying patients based on their risk of requiring ICU admission, which can guide clinicians in making decisions about the level of care needed. It takes into account various factors including patient demographics, clinical characteristics, and laboratory results. 

There are no specific exclusion criteria for the use of the ACTION score, but it should be noted that it is not applicable to patients with other types of heart attacks, such as ST-segment Elevation Myocardial Infarction (STEMI), or to patients with chest pain of non-cardiac origin. It is also less accurate in patients with missing data for any of the variables included in the score.

ACTION score for risk of ICU admission in NSTEMI

The INTERCHEST clinical prediction rule is a tool designed to evaluate the risk of coronary artery disease (CAD) in patients who present with chest pain in a primary care scenario. This assessment is achieved by reviewing a set of six distinct factors, each asking for a simple yes or no answer, which ultimately calculates a score indicating the likelihood of CAD.

These are the factors considered in the INTERCHEST rule:

- Is the patient male and aged 55 years or older, or female and aged 65 years or older?
- Does the patient have a history of coronary artery disease?
- Did the physician initially suspect a serious condition based on the patient's presentation?
- Does the chest discomfort feel like pressure to the patient?
- Is the chest pain related to physical effort or exertion?
- Can the pain be reproduced when the physician applies physical palpation?

Each affirmative answer to these questions adds one point to the total score, while a negative answer adds no points. Thus, the total score ranges from 0 to 6.

The interpretation of the INTERCHEST score helps guide clinical decision-making:

- A score of 1 or below indicates a low risk of coronary artery disease. This is related to an estimated CAD prevalence of about 2.1%.
- A score of 2 or above suggests a high risk, implying an estimated CAD prevalence of 43.0%.

This scoring system helps healthcare providers stratify risk and decide further management steps for patients with chest pain, ensuring that those who might need more intensive investigation or immediate intervention are identified promptly.

The INTERCHEST clinical prediction rule is a diagnostic tool used in primary care settings to evaluate patients presenting with chest pain. The name "INTERCHEST" is an abbreviation derived from the study "International Chest pain prediction rule" which developed this tool. 

This calculator is specifically designed for adult patients who present to primary care with chest pain. Its primary clinical utility is to help clinicians estimate the probability of coronary artery disease (CAD) in these patients. By considering various patient characteristics and symptoms, the INTERCHEST rule provides a score that can predict the likelihood of CAD, thereby aiding in decision-making about further diagnostic testing and management.

The INTERCHEST rule should not be used in patients with known CAD, those with a clear alternative diagnosis for their chest pain, or those with chest pain due to trauma. It is also not intended for use in emergency settings, where more acute causes of chest pain (such as myocardial infarction) need to be ruled out.

INTERCHEST clinical prediction rule for chest pain in primary care

The Revised Cardiac Risk Index (RCRI) calculator assesses perioperative cardiac risks by taking into account six specific risk factors associated with the patient. Each factor corresponds to a condition or characteristic, and if the patient exhibits that factor, it scores 1 point. The total score, ranging from 0 to 6, represents the overall cardiac risk.

The six risk factors analyzed are as follows:
1. High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular surgery)
2. History of ischemic heart disease (including myocardial infarction, positive exercise test, ECG with pathological Q waves, current ischemic chest pain, or use of nitrate)
3. History of congestive heart failure (with manifestations such as pulmonary edema, bilateral rales, S3 gallop, paroxysmal nocturnal dyspnea, or pulmonary vascular redistribution on chest X-ray)
4. History of cerebrovascular disease (transient ischemic attack or stroke)
5. Use of insulin for diabetes
6. Preoperative creatinine level above 2 mg/dL or 178 mcmol/L

A boolean input for each risk factor determines its presence, scoring 1 point if true and 0 if false. The sum of these points results in the total score.

Based on the computed score, the calculator provides an interpretation reflecting the patient's estimated risk of experiencing a major cardiac event (MI, cardiac arrest, or mortality) within 30 days post-surgery:

- Score of 0: Risk is 3.9%
- Score of 1: Risk is 6.0%
- Score of 2: Risk is 10.1%
- Score of 3 or more: Risk is 15.0%

The calculator simplifies the complex assessment of cardiac perioperative risks into a quantifiable measure, guiding healthcare providers in evaluating and mitigating potential cardiac complications in surgical patients. Here is the summary of how scores are interpreted in relation to risk percentages:

| Score | Risk Interpretation                                  |
|-------|------------------------------------------------------|
| 0     | Risk of 30-day MI, cardiac arrest, or mortality is 3.9% |
| 1     | Risk of 30-day MI, cardiac arrest, or mortality is 6.0% |
| 2     | Risk of 30-day MI, cardiac arrest, or mortality is 10.1% |
| 3 or more | Risk of 30-day MI, cardiac arrest, or mortality is 15.0% |

This structured approach helps balance the decision-making process by providing a clear estimate of cardiac risk based on specific, patient-related factors.

The Revised Cardiac Risk Index (RCRI) is a clinical calculator used to estimate the risk of cardiac complications during the perioperative period in patients undergoing non-cardiac surgery. It is particularly useful for stratifying patients into different risk categories based on six identified risk factors: high-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy for diabetes, and preoperative serum creatinine >2.0 mg/dL. 

The RCRI is not applicable to patients undergoing cardiac surgery, as it was specifically designed for non-cardiac surgical procedures. It also may not be as accurate in populations not represented in the original study, such as those with less common comorbidities or undergoing less common surgical procedures.

Revised Cardiac Risk Index for perioperative risks (RCRI)

The calculator evaluates the likelihood of myocardial infarction (MI) in patients with a left bundle branch block by analyzing three specific ECG criteria. Here's how the scoring system works:

- If there is ST-segment elevation of at least 1 mm that occurs in the same direction as the QRS complex, this contributes 5 points to the total score.
- An ST-segment depression of 1 mm or more in ECG leads V1, V2, or V3 adds 3 points.
- If there is any excessively discordant ST elevation or depression in any one lead, 2 points are added.

For each criterion that is true, the corresponding points are summed to obtain an overall score. For example, if a patient exhibits both an ST-segment elevation concordant with the QRS complex and excessively discordant ST changes, the total score would be 7, calculated as 5 points for the first criterion plus 2 points for the third one. Should none of the criteria be met, the resulting score would be 0.

The interpretation of the total score helps guide clinical decision-making regarding myocardial infarction:

- A score of less than 3 suggests that a myocardial infarction is unlikely to have occurred.
- A score of 3 or higher indicates that a myocardial infarction is likely.

The calculator outputs a total score ranging from 0 to 10, accompanied by an interpretation to help evaluate the probability of myocardial infarction based on these thresholds.

The calculator in question is Sgarbossa's Criteria for Myocardial Infarction (MI) in Left Bundle Branch Block (LBBB). This scoring system is used in patients who present with symptoms suggestive of acute myocardial infarction but have a pre-existing left bundle branch block on their electrocardiogram (ECG). 

The clinical utility of Sgarbossa's Criteria lies in its ability to help clinicians identify acute myocardial infarction in the setting of LBBB, a condition that can make ECG interpretation challenging. The criteria consist of three ECG findings, each assigned a different point value. A total score of 3 or more is considered indicative of acute MI.

There are no specific exclusion criteria for the use of Sgarbossa's Criteria. However, it should be noted that this scoring system is not applicable in patients without LBBB or in those with right bundle branch block. Furthermore, it is not a substitute for clinical judgment and should be used in conjunction with other clinical findings and diagnostic tests.

Sgarbossa's criteria for MI in left bundle branch block

The TIMI score for unstable angina/non-ST-elevation myocardial infarction calculator evaluates a patient's risk profile based on seven specific input criteria. Each criterion, if met, contributes one point to the patient's total TIMI score. The final score is used to assess the patient's likelihood of experiencing adverse cardiac events within 14 days.

To calculate the TIMI score, the following criteria are considered, each contributing 1 point if present:
1. Age >= 65 years
2. Presence of >= 3 risk factors for coronary artery disease (such as family history, hypertension, hypercholesterolemia, diabetes, current smoking)
3. Presence of significant coronary stenosis >= 50%
4. Use of aspirin in the past 7 days
5. Severe angina with >= 2 anginal events in 24 hours
6. Evidence of ST deviation on ECG
7. Presence of elevated serum cardiac markers

The computation involves assessing each of these conditions and summing the corresponding points. The total score, which ranges from 0 to 7, is used to interpret the patient's risk for adverse outcomes:

- A score of 0 or 1 suggests a 5% risk of all-cause mortality, new or recurrent myocardial infarction (MI), or severe recurrent ischemia requiring urgent revascularization within 14 days.
- A score of 2 indicates an 8% risk.
- A score of 3 corresponds to a 13% risk.
- A score of 4 signifies a 20% risk.
- A score of 5 represents a 26% risk.
- A score of 6 or higher suggests a 41% risk.

The TIMI (Thrombolysis in Myocardial Infarction) score for Unstable Angina/Non-ST Elevation Myocardial Infarction (UA/NSTEMI) is a clinical tool used to stratify risk in patients presenting with chest pain suggestive of acute coronary syndrome. This scoring system applies specifically to patients with unstable angina or non-ST elevation myocardial infarction.

The TIMI score for UA/NSTEMI helps clinicians predict the likelihood of major adverse cardiac events (MACE) within a 14-day period following presentation. These events include all-cause mortality, new or recurrent myocardial infarction, or severe recurrent ischemia requiring urgent revascularization.

The score is calculated based on seven variables: age ≥65 years, at least three risk factors for coronary artery disease, prior coronary stenosis of ≥50%, ST-segment deviation on ECG at presentation, at least two anginal events in the prior 24 hours, use of aspirin in the past seven days, and elevated serum cardiac markers. Each variable is assigned 1 point, and the total score ranges from 0 to 7.

There are no specific exclusion criteria for the use of the TIMI score for UA/NSTEMI. However, it

TIMI score for unstable angina/non-ST-elevation myocardial infarction

The Canadian Cardiovascular Society (CCS) grading scale is a tool designed to classify the severity of angina pectoris based on the level of physical activity that provokes symptoms. The calculator assesses a user's description of their angina symptoms during specific activities and assigns one of four CCS classes, ranging from Class I to Class IV. This classification helps understand the impact of angina on daily activities and overall physical capacity.

To use this scale, the input required is a description of when angina occurs:

- Class I: Angina does not occur with ordinary physical activity such as walking or climbing stairs. It only happens during strenuous, rapid, or prolonged exertion at work or during recreation.
- Class II: There is a slight limitation of ordinary activity. Angina may develop during rapid walking or stair climbing, walking uphill, or other specific conditions such as emotional stress or walking more than two blocks.
- Class III: There is a marked limitation of ordinary physical activity. Angina occurs with walking one to two blocks on level ground or climbing one flight of stairs at a normal pace.
- Class IV: There is an inability to perform any physical activity without discomfort. Anginal symptoms can even be present at rest.

Once a user selects a description that best fits their experience, the calculator categorizes the angina severity accordingly:

- Select the description that involves no angina during typical activities and only occurs with harder exertions, and the classification is "Class I".
- Choose the description indicating slight restriction with specific activities or stress, and the label will be "Class II".
- Select the description noting marked restriction with regular activities like limited walking or climbing, and the category is "Class III".
- Choose the description showing an inability to perform any physical activities without discomfort, and the classification results in "Class IV".

This scale helps users and healthcare professionals understand and communicate the extent to which angina affects physical activities, aiding in treatment planning and lifestyle adjustments.

The Canadian Cardiovascular Society (CCS) Grading Scale for Angina Pectoris is a clinical calculator used to assess the severity of angina in patients with known or suspected coronary artery disease. This scale is applicable to patients experiencing chest pain or discomfort that is suspected to be caused by coronary heart disease. 

The CCS scale is a four-grade system, with Grade I representing the mildest form of angina and Grade IV the most severe. It is used to guide treatment decisions and to assess the effectiveness of treatment interventions. 

The clinical utility of the CCS scale lies in its ability to stratify patients based on the severity of their symptoms, which can help in predicting prognosis and guiding therapeutic decisions. It is also useful in monitoring disease progression and response to treatment.

There are no specific exclusion criteria for the use of the CCS scale. However, it should be noted that this scale is not designed to diagnose angina or coronary artery disease, but rather to grade the severity of angina in patients with a confirmed or suspected diagnosis. Therefore, it may not be applicable in patients with chest pain of non-cardiac origin.

Canadian Cardiovascular Society grading scale for angina pectoris (CCS scale)

The Dual Antiplatelet Therapy (DAPT) score calculator helps determine whether a patient should continue prolonged dual antiplatelet therapy by assessing various clinical factors. This process involves several steps to collect inputs from the patient and compute the score.

First, gather information about the patient:

- Age (categorized as either 75 years or older, between 65 and 74 years, or under 65 years)
- Presence of diabetes mellitus
- Current smoking status
- History of prior percutaneous coronary intervention or myocardial infarction
- History of congestive heart failure or a left ventricular ejection fraction of less than 30%
- If they experienced an acute myocardial infarction at presentation
- Past procedures involving percutaneous coronary intervention or vein graft stenting
- Implantation of a paclitaxel-eluting stent
- Stent diameter being less than 3 mm

These factors are then scored as follows:

| Parameter                                                                                           | Score |
|-----------------------------------------------------------------------------------------------------|-------|
| Age, years >= 75                                                                                    | 2     |
| Age, years 65-74                                                                                    | 1     |
| Age, years < 65                                                                                     | 0     |
| Diabetes mellitus (Yes)                                                                             | 1     |
| Diabetes mellitus (No)                                                                              | 0     |
| Current smoker (Yes)                                                                                | 1     |
| Current smoker (No)                                                                                 | 0     |
| Prior percutaneous coronary intervention or myocardial infarction (Yes)                             | 1     |
| Prior percutaneous coronary intervention or myocardial infarction (No)                              | 0     |
| History of congestive heart failure or left ventricular ejection fraction < 30% (Yes)               | 2     |
| History of congestive heart failure or left ventricular ejection fraction < 30% (No)                | 0     |
| Acute myocardial infarction at presentation (Yes)                                                   | 1     |
| Acute myocardial infarction at presentation (No)                                                    | 0     |
| Percutaneous coronary intervention or vein graft stent (Yes)                                        | 2     |
| Percutaneous coronary intervention or vein graft stent (No)                                         | 0     |
| Implantation of paclitaxel-eluting stent (Yes)                                                      | 1     |
| Implantation of paclitaxel-eluting stent (No)                                                       | 0     |
| Stent diameter < 3 mm (Yes)                                                                         | 1     |
| Stent diameter < 3 mm (No)                                                                          | 0     |

The final DAPT score is calculated by summing the scores corresponding to the patient's characteristics.

Interpretation of the total DAPT score guides the clinical decision regarding therapy duration:

- A score of 0 or 1 suggests the bleeding risks are greater than the ischemic benefits, indicating that extended dual antiplatelet therapy should be avoided.
- A score of 2 or more implies that ischemic benefits outweigh bleeding risks, which may favor consideration for prolonged therapy.

This result, comprising the overall score and its interpretation, aids physicians in crafting a treatment plan tailored to the patient's needs.

The Dual Antiplatelet Therapy Score, or DAPT Score, is a clinical calculator used in the management of patients who have undergone percutaneous coronary intervention (PCI) with stenting. This scoring system is used to weigh the risks and benefits of continuing dual antiplatelet therapy beyond 12 months after stent placement. 

The DAPT Score takes into account various patient and procedural factors such as age, history of diabetes, prior myocardial infarction, stent diameter, and congestive heart failure or left ventricular ejection fraction (LVEF) <30%, among others. A higher score indicates a greater potential benefit from extended dual antiplatelet therapy, while a lower score suggests that the risks (such as bleeding complications) may outweigh the benefits.

This calculator is not applicable to patients who have not undergone PCI with stenting, or those who have contraindications to prolonged antiplatelet therapy, such as a high risk of bleeding or a history of hemorrhagic stroke.

Dual Antiplatelet Therapy score (DAPT score)

The Modified Sgarbossa's criteria calculator evaluates the likelihood of a myocardial infarction (MI) in the context of a left bundle branch block (LBBB) by examining three critical electrocardiographic features. By reviewing each feature and applying a defined scoring system, it offers a systematic way to assess the presence of MI. 

Here's how it works:

1. **ST elevation ≥ 1 mm concordant with the QRS complex in at least one lead**:
   - Answering "Yes" earns 1 point.
   - Answering "No" earns 0 points.

2. **ST depression ≥ 1 mm in lead V1, V2, or V3**:
   - Answering "Yes" earns 1 point.
   - Answering "No" earns 0 points.

3. **Excessively discordant ST deviation**:
   - This feature is identified based on an ST/S ratio in any lead showing > 1 mm ST-segment elevation or depression.
   - Answering "Yes" earns 1 point.
   - Answering "No" earns 0 points.

After evaluating these inputs, the calculator sums the points to produce a total score ranging from 0 to 3. A higher total score suggests a stronger indication of MI.

Interpretation of the score is straightforward:
- A score of 1 or more supports the criteria for myocardial infarction, highlighting an increased probability of MI when LBBB is present.
- A score of 0 indicates that the criteria for myocardial infarction are not met, implying a lower likelihood of MI given the context. 

This systematic approach aids healthcare professionals in making informed clinical decisions about potential coronary events in patients with complex ECG patterns due to LBBB.

The Modified Sgarbossa's Criteria is a clinical calculator used for diagnosing myocardial infarction (MI) in patients with a pre-existing left bundle branch block (LBBB) or ventricular paced rhythm. This calculator is particularly useful in the emergency department setting where rapid diagnosis of MI is critical. 

The Modified Sgarbossa's Criteria applies to patients presenting with chest pain or other symptoms suggestive of MI who have an ECG showing LBBB or a ventricular paced rhythm. These ECG patterns can make it difficult to diagnose MI using standard criteria, hence the need for the Modified Sgarbossa's Criteria.

The clinical utility of this calculator is to aid in the diagnosis of MI in this specific patient population, which can guide appropriate treatment and management decisions. 

There are no specific exclusion criteria for the use of the Modified Sgarbossa's Criteria. However, it should be noted that this calculator is not intended to replace clinical judgment and should be used in conjunction with other clinical findings and diagnostic tests.

Modified Sgarbossa's criteria for MI in left bundle branch block

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

NYHA functional classification for heart failure

Non-ST-elevation myocardial infarction

Perioperative management of antithrombotics

Indications for coronary artery bypass graft

Indications for CABG

Patients with chronic kidney disease

Patients with CKD

Healthcare system and hospital requirements

Healthcare system and hospital requirements (pre-hospital settings)

Electrocardiogram monitoring

ECG monitoring

As per ACC/ACEP/AHA/…/SCAI 2025 guidelines, 

Cardiopulmonary bypass

Patients with stress cardiomyopathy

Patients with myocardial infarction with nonobstructive coronary arteries

Patients with MINOCA

Cardiac rehabilitation

Bypass conduits

Transfer

Antiplatelet therapy

Antiplatelet therapy, P2Y12 inhibitors, initiation

Psychological interventions

History and physical examination

Influenza immunization

Smoking cessation

Prognostic assessment

Patients with diabetes mellitus

Patient-centered care

Patients scheduled for noncardiac surgery

As per ACC/ACS/AHA/…/SVM 2024 guidelines, 

General principles

Patients with microvascular angina

Intraoperative insulin infusion

Calcium channel blockers

CCBs

Counseling before discharge

Statin therapy

Hormone therapy

Lifestyle modifications

Management of pain and anxiety

Patients with atrial fibrillation

Patients with AF

Management of ventricular arrhythmias

Management of ventricular arrhythmias (radiofrequency ablation)

Patients with preexisting heart failure

Patients with preexisting HF

Low-dose aspirin

Supplemental oxygen

Indications for percutaneous coronary intervention

Indications for PCI

Patients with spontaneous coronary artery dissection

Elderly patients

Vitamin supplements

Female patients

Patients with postoperative myocardial infarction

Diagnosis

Shared-decision making

Patients with cancer

Management of cardiogenic shock

Management of cardiogenic shock, intra-aortic balloon counterpulsation

Management of atrial fibrillation

Management of AF, antithrombotic therapy

Cocaine and methamphetamine users

Anticoagulant therapy

Perioperative amiodarone

Electrocardiogram

Pregnant patients

Management of bradyarrhythmias

Patients with vasospastic angina

Perioperative beta-blockers

Antiplatelet therapy, aspirin

Renin-angiotensin system inhibitors

RAS inhibitors

Management of dyslipidemia

Fibrinolytic therapy

Coronary angiography

Technical considerations for percutaneous coronary intervention

Technical considerations for PCI, intravascular imaging

Technical considerations for PCI, multivessel disease

Management of cardiogenic shock, mechanical circulatory support

Setting of monitoring

Imaging monitoring

Lipid monitoring

Management of cardiogenic shock, revascularization

Cardiac troponin

Antiplatelet therapy, intravenous GP IIb/IIIa inhibitors

Low-dose colchicine

Cardiac magnetic resonance imaging

Cardiac MRI

Coronary computed tomography angiography

Coronary CTA

Beta-blockers

Beta-blockers, PO

The American College of Cardiology (ACC) and American Heart Association (AHA) have updated their guidelines for the management of non-ST-elevation acute coronary syndromes (NSTE-ACS). A routine invasive approach is recommended for high- and intermediate-risk patients, while a routine or selective invasive approach is suggested for low-risk patients. Angiography before hospital discharge is suggested for non-high-risk patients intended for an invasive strategy. Upstream clopidogrel or ticagrelor is suggested for patients planned for an invasive strategy when angiography is expected to be delayed >24 hours, while ticagrelor is recommended for those managed without planned invasive evaluation. PCI of significant non-culprit lesions is recommended at the time of the index procedure or as a staged procedure in stable patients with multivessel disease but without left main stenosis undergoing culprit-lesion PCI.


Non-ST-elevation myocardial infarction

Guidelines

Key sources