First-Line Treatment of Non-ST-Elevation Myocardial Infarction (NSTEMI)
Non-ST-elevation myocardial infarction (NSTEMI) is an acute coronary syndrome requiring prompt, structured intervention to limit myocardial injury, reduce ischemic events, and restore adequate oxygen delivery.
Clinical Goals
Increase oxygen saturation to ≥90% and achieve relief of anginal and ischemic chest pain.
Treatment Approach
Initial management involves combined antiplatelet therapy, anticoagulation, and lipid-lowering treatment, together with additional cardioprotective agents and targeted measures addressing hypoxia and ischemic symptoms.
Agent selection, sequencing criteria, and the complete regimen are available in the full protocol below.
References
DOI: 10.1161/CIR.0000000000001309
- In patients with ACS, an initial oral loading dose of aspirin, followed by daily low-dose aspirin, is recommended to reduce death and MACE.
- In patients with ACS, an oral P2Y12 inhibitor should be administered in addition to aspirin to reduce MACE.
- In patients with NSTE-ACS, intravenous unfractionated heparin (UFH) is useful to reduce ischemic events.
- In patients with ACS, high-intensity statin therapy is recommended to reduce the risk of MACE.
- In patients with ACS and confirmed hypoxia (oxygen saturation <90%), supplemental oxygen to increase oxygen saturations to ≥90% is recommended to improve myocardial oxygen supply and decrease anginal symptoms.
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