{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzn2xq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzn2xq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/3\\\/6\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/3\\\/6\u0022}],\u0022ac\u0022:{\u0022spmdc;11\\\/3\\\/6\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;11\\\/3\\\/6\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEach year, the American College of Cardiology Foundation (ACCF) introduces new and\/or updated Clinical Practice Guidelines that represent the most current evidence-based medicine. Selected recommendations from two Practice Guidelines follow.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEach year, the American College of Cardiology Foundation (ACCF) introduces new and\/or updated Clinical Practice Guidelines that represent the most current evidence-based medicine. Selected recommendations from two Practice Guidelines follow.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EJonathan L. Halperin, MD, Mt. Sinai Medical Center, New York, New York, USA, and Thomas Brott, MD, Mayo Clinic, Jacksonville, Florida, USA, jointly presented some of the key guidelines from the 2011 Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease (ECVD).\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENew Guideline:\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\n            \u003Cem\u003EAsymptomatic Patients with Known\/Suspected Carotid Stenosis\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-5\u0022\u003EDuplex ultrasonography is recommended as the initial diagnostic test to detect hemodynamically significant carotid stenosis in patients with known or suspected carotid stenosis but not for routine screening of asymptomatic patients with no clinical manifestations of or risk factors for atherosclerosis.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-6\u0022\u003E\n            \u003Cem\u003EPatients with Symptoms or Signs of ECVD\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003EThe initial evaluation should include noninvasive imaging for the detection of ECVD. However, in patients with symptoms of a territorial stroke or transient ischemic attack (TIA), in which sonography either can not be obtained or yields equivocal or otherwise nondiagnostic results, magnetic resonance or computed tomography angiography should be performed.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-8\u0022\u003E\n            \u003Cem\u003EAntithrombotic Therapy\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EIn patients who have had ischemic stroke or TIA, aspirin, clopidogrel, or aspirin+extended-release dipyridamole is recommended and preferred over clopidogrel+aspirin due to the risk of bleeding, unless there is another indication for dual antiplatelet therapy (eg, recent ACS or coronary stenting).\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EIn patients with carotid disease, with or without ischemic symptoms, antiplatelet agents are recommended rather than oral anticoagulation for prevention of stroke.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EThe use of a vitamin K antagonist can be beneficial in patients with atrial fibrillation (AF), a mechanical prosthetic heart valve, or specific indications for anticoagulant therapy.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\n            \u003Cem\u003ESelection of Patients for Carotid Revascularization\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-4\u0022\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-13\u0022\u003EFor patients with TIA or stroke, intervention within 2 weeks of the index event is reasonable.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-14\u0022\u003ESymptomatic patients at average\/low surgical risk should undergo carotid endarterectomy (CEA) if the diameter of the lumen of the ipsilateral internal carotid artery is reduced by \u0026gt;70% (or \u0026gt;50% on catheter angiography).\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n               \u003Cp id=\u0022p-15\u0022\u003ECEA is reasonable in asymptomatic patients with \u0026gt;70% stenosis.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n               \u003Cp id=\u0022p-16\u0022\u003EIt is reasonable to choose CEA over carotid artery stenting (CAS) in older patients, particularly when the arterial pathoanatomy is unfavorable for endovascular intervention.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n               \u003Cp id=\u0022p-17\u0022\u003ECAS is indicated as an alternative to CEA for symptomatic patients at average\/low risk of complications that are associated with endovascular intervention.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n               \u003Cp id=\u0022p-18\u0022\u003EIt is reasonable to choose CAS over CEA in patients with unfavorable neck anatomy (eg, arterial stenosis distal to the second cervical vertebra or proximal arterial stenosis).\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n               \u003Cp id=\u0022p-19\u0022\u003ECAS might be considered in highly selected patients with asymptomatic carotid stenosis, but its effectiveness compared with medical therapy alone in this situation is not well established.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n               \u003Cp id=\u0022p-20\u0022\u003EIn symptomatic or asymptomatic patients at high risk, the effectiveness of revascularization versus medical therapy alone is not well established.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-21\u0022\u003E\n            \u003Cem\u003EManagement of Patients Undergoing Endovascular CAS\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-5\u0022\u003E\u003Cli id=\u0022list-item-14\u0022\u003E\n               \u003Cp id=\u0022p-22\u0022\u003EBefore CAS, and for a minimum of 30 days after, dual antiplatelet therapy with aspirin+clopidogrel is recommended.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-15\u0022\u003E\n               \u003Cp id=\u0022p-23\u0022\u003EEmbolic protection device deployment during CAS can be beneficial in reducing the risk of stroke.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-24\u0022\u003E\n            \u003Cem\u003EManagement of Patients Experiencing Restenosis After CEA or CAS\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-6\u0022\u003E\u003Cli id=\u0022list-item-16\u0022\u003E\n               \u003Cp id=\u0022p-25\u0022\u003EIn patients with symptomatic cerebral ischemia and recurrent carotid stenosis due to intimal hyperplasia or atherosclerosis, it is reasonable to repeat CEA or perform CAS.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-17\u0022\u003E\n               \u003Cp id=\u0022p-26\u0022\u003EIn asymptomatic patients, reoperative CEA or CAS may be considered.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-27\u0022\u003E\n            \u003Cem\u003ECarotid Artery Evaluation and Revascularization Before Cardiac Surgery\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-7\u0022\u003E\u003Cli id=\u0022list-item-18\u0022\u003E\n               \u003Cp id=\u0022p-28\u0022\u003ECEA or CAS before or concurrent with myocardial revascularization surgery is reasonable in patients with \u0026gt;80% carotid stenosis who have experienced symptoms within 6 months.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-19\u0022\u003E\n               \u003Cp id=\u0022p-29\u0022\u003EIn asymptomatic patients with carotid stenosis, even if severe, the safety and efficacy of carotid revascularization before or concurrent with myocardial revascularization is not well established.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-30\u0022\u003ER. Scott Wright, MD, Mayo Clinic, Rochester, Minnesota, USA, and Jeffrey L. Anderson, MD, Intermountain Medical Center, Murray, Utah, USA, presented key changes in the 2011 ACCF\/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina\/Non-ST-Elevation Myocardial Infarction (UA\/NSTEMI):\u003C\/p\u003E\n         \u003Cp id=\u0022p-31\u0022\u003E\n            \u003Cem\u003EAntiplatelet Therapy (NEW)\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-8\u0022\u003E\u003Cli id=\u0022list-item-20\u0022\u003E\n               \u003Cp id=\u0022p-32\u0022\u003EA loading dose of thienopyridine is recommended in patients for whom PCI is planned. Regimens should be either clopidogrel 300 to 600 mg, given as early as possible before or at the time of PCI, or prasugrel 60 mg, given promptly and no later than 1 hour after PCI once coronary anatomy is defined and a decision is made to proceed with PCI.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-21\u0022\u003E\n               \u003Cp id=\u0022p-33\u0022\u003EThe maintenance dose and duration of thienopyridine therapy should be clopidogrel 75 mg daily or prasugrel 10 mg daily for at least 12 months in patients undergoing PCI; however, if the risk of morbidity due to bleeding outweighs the anticipated benefits afforded by thienopyridine therapy, earlier discontinuation should be considered.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-22\u0022\u003E\n               \u003Cp id=\u0022p-34\u0022\u003EIn patients at low risk for ischemic events (eg, TIMI risk score \u22642) or at high risk of bleeding, and who are already receiving aspirin + clopidogrel, upstream GP IIIb\/IIIa inhibitors are not recommended.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-23\u0022\u003E\n               \u003Cp id=\u0022p-35\u0022\u003EIn patients with a prior history of stroke and\/or TIA for whom PCI is planned, prasugrel is potentially harmful as part of a dual antiplatelet therapy regimen.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-24\u0022\u003E\n               \u003Cp id=\u0022p-36\u0022\u003EContinuation of clopidogrel or prasugrel beyond 15 months may be considered following placement of a drug-eluting stent.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-25\u0022\u003E\n               \u003Cp id=\u0022p-37\u0022\u003EPrasugrel 60 mg may be considered for administration promptly upon presentation in patients with UA\/NSTEMI for whom PCI is planned, before definition of coronary anatomy, if both the risk for bleeding is low and the need for CABG is considered unlikely.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-26\u0022\u003E\n               \u003Cp id=\u0022p-38\u0022\u003EThe use of upstream GP IIb\/IIIa inhibitors may be considered in high-risk UA\/NSTEMI patients already receiving acetylsalicylic acid (ASA) and a thienopyridine who are selected for an invasive strategy; this includes patients with elevated troponin levels, diabetes, or significant ST segment depression and those who are not otherwise at high risk for bleeding.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-27\u0022\u003E\n               \u003Cp id=\u0022p-39\u0022\u003EIn patients with definite UA\/NSTEMI undergoing PCI as part of an early invasive strategy, the use of a loading dose of clopidogrel 600 mg, followed by a higher maintenance dose of 150 mg daily for 6 days, then 75 mg daily, may be reasonable in patients not considered at high risk for bleeding.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-40\u0022\u003E\n            \u003Cem\u003EAdditional Management of Antiplatelet and Anticoagulant Therapy (NEW)\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-9\u0022\u003E\u003Cli id=\u0022list-item-28\u0022\u003E\n               \u003Cp id=\u0022p-41\u0022\u003EPlatelet function testing to determine platelet inhibitory response in patients with UA\/NSTEMI (or ACS with PCI) on thienopyridine therapy may be considered if results of testing may alter management.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-29\u0022\u003E\n               \u003Cp id=\u0022p-42\u0022\u003EGenotyping for a CYP2C19 loss-of-function variant in patients with UA\/NSTEMI (or ACS with PCI) on clopidogrel therapy might be considered if results of testing may alter management.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-43\u0022\u003E\n            \u003Cem\u003EPatients with Chronic Kidney Disease (NEW)\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-10\u0022\u003E\u003Cli id=\u0022list-item-30\u0022\u003E\n               \u003Cp id=\u0022p-44\u0022\u003EPatients undergoing cardiac catherization with receipt of contrast media should receive adequate preparatory hydration.\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-31\u0022\u003E\n               \u003Cp id=\u0022p-45\u0022\u003ECalculation of the contrast volume:creatinine clearance ratio is useful in predicting the maximum volume of contrast media that can be given without significantly increasing the risk of contrast-associated nephropathy.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-46\u0022\u003E\n            \u003Cem\u003EPatients with Diabetes Mellitus (MODIFIED)\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-11\u0022\u003E\u003Cli id=\u0022list-item-32\u0022\u003E\n               \u003Cp id=\u0022p-47\u0022\u003EFor patients hospitalized with UA\/STEMI (either complicated or uncomplicated course), it is reasonable to use an insulin-based regimen to achieve and maintain glucose levels \u0026lt;180 mg\/dL while avoiding hypoglycemia.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-48\u0022\u003E\n            \u003Cem\u003EInitial Invasive vs Initial Conservative Strategies (NEW)\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-12\u0022\u003E\u003Cli id=\u0022list-item-33\u0022\u003E\n               \u003Cp id=\u0022p-49\u0022\u003EIt is reasonable to choose an early invasive strategy (within 12 to 24 hours of admission) over a delayed invasive strategy for initially stabilized high-risk patients with UA\/NSTEMI. For patients not at high risk, a delayed invasive strategy approach is also reasonable.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-50\u0022\u003EThe complete ACCF\/AHA Clinical Practice Guidelines are available online at: \u003Ca href=\u0022http:\/\/content.onlinejacc.org\/misc\/guidelines.dtl\u0022\u003Ehttp:\/\/content.onlinejacc.org\/misc\/guidelines.dtl\u003C\/a\u003E.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAre There Differences Between ACC\/AHA and ESC STEMI Guidelines?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-51\u0022\u003ERobert P. Giugliano, MD, Brigham \u0026amp; Women\u0027s Hospital, Boston, Massachusetts, USA, discussed the similarities and differences between the ACC\/American Heart Association (ACC\/AHA) and European Society of Cardiology (ESC) Guidelines.\u003C\/p\u003E\n         \u003Cp id=\u0022p-52\u0022\u003E\u201cOverall,\u201d said Dr. Giugliano, \u201cthe guidelines for patients with STEMI published by the ACC\/AHA and the ESC are similar in terms of approach (ie, structure, rigor, and classification and level of evidence), the types of guidelines (eg, both full and focused updates), and the versions that are offered (eg, pocket, web, etc). The differences lie primarily in the areas of style, scope\/timing, attitude, and belief.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-53\u0022\u003EIn a 2009 publication, Dr. Giugliano and Dr. Deepak Thomas compared the then-current guidelines for management of STEMI, as issued by the ACC\/AHA [2007: Antman EM et al. \u003Cem\u003EJ Am Col Cardiol\u003C\/em\u003E 2008] and ESC [2008: Van de Werf F et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008; Thomas D \u0026amp; Giugliano RP. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2009]. Both guidelines contain key changes, and among them there was vigorous agreement in 4 areas:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-13\u0022\u003E\u003Cli id=\u0022list-item-34\u0022\u003E\n               \u003Cp id=\u0022p-54\u0022\u003Egreater detail on the selection of a reperfusion strategy\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-35\u0022\u003E\n               \u003Cp id=\u0022p-55\u0022\u003Enew data and recommendations on adjunctive anticoagulants\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-36\u0022\u003E\n               \u003Cp id=\u0022p-56\u0022\u003Ecaution regarding IV \u03b2-blockers\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-37\u0022\u003E\n               \u003Cp id=\u0022p-57\u0022\u003Emore aggressive secondary risk management\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-58\u0022\u003EIn this comparison, the authors found only very few differences in belief or attitude. Most of the differences were in style or possibly associated with the scope or timing of the review\/release (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12270\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12270\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12270\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-59\u0022 class=\u0022first-child\u0022\u003ESelected Comparison Between the 2007 AHA\/ACC and 2008 ESC Guidelines for STEMI.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-63\u0022\u003EDr. Giugliano also summarized key changes from two newer AHA\/ACC focused updates that introduced both new indications and changes to existing Class I recommendations:\u003C\/p\u003E\n         \u003Cul class=\u0022list-simple \u0022 id=\u0022list-14\u0022\u003E\u003Cli id=\u0022list-item-38\u0022\u003E\n               \n               \u003Cp id=\u0022p-64\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E1. \u003C\/span\u003EThe 2009 Focused Updates: ACC\/AHA Guidelines for the Management of Patients With STEMI; ACC\/AHA\/SCAI Guidelines on Percutaneous Coronary Intervention (PCI) [Kushner FG et al. \u003Cem\u003EJ Am Col Cardiol\u003C\/em\u003E 2009] introduced 5 new Class I indications:\u003C\/p\u003E\n               \u003Cul class=\u0022list-unord \u0022 id=\u0022list-15\u0022\u003E\u003Cli id=\u0022list-item-39\u0022\u003E\n                     \u003Cp id=\u0022p-65\u0022\u003EPrasugrel ASAP as an alternative to clopidogrel in STEMI\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-40\u0022\u003E\n                     \u003Cp id=\u0022p-66\u0022\u003EDual antiplatelet therapy can now incorporate either clopidogrel or prasugrel along with aspirin in non-ST-elevation myocardial infarction (NSTEMI)\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-41\u0022\u003E\n                     \u003Cp id=\u0022p-67\u0022\u003ECommunity-based STEMI systems\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-42\u0022\u003E\n                     \u003Cp id=\u0022p-68\u0022\u003EThienopyridine for \u226512 months after placement of a bare metal stent\u003C\/p\u003E\n                  \u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-69\u0022\u003EThere are now specific contrast agents that are preferred for patients with chronic kidney disease who are not on dialysis\u003C\/p\u003E\n         \u003Cul class=\u0022list-simple \u0022 id=\u0022list-16\u0022\u003E\u003Cli id=\u0022list-item-43\u0022\u003E\n               \n               \u003Cp id=\u0022p-70\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E2. \u003C\/span\u003EThe 2011 ACC\/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina\/NSTEMI [Wright RS et al. \u003Cem\u003EJ Am Col Cardiol\u003C\/em\u003E 2011] instituted five changes to the Class I recommendations:\u003C\/p\u003E\n               \u003Cul class=\u0022list-unord \u0022 id=\u0022list-17\u0022\u003E\u003Cli id=\u0022list-item-44\u0022\u003E\n                     \u003Cp id=\u0022p-71\u0022\u003EAdded prasugrel as an alternative to clopidogrel\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-45\u0022\u003E\n                     \u003Cp id=\u0022p-72\u0022\u003ELoading dose of clopidogrel now up to 600 mg\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-46\u0022\u003E\n                     \u003Cp id=\u0022p-73\u0022\u003EExtension of thienopyridine therapy to at least 12 months whether patients are managed medically or invasively\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-47\u0022\u003E\n                     \u003Cp id=\u0022p-74\u0022\u003EDeleted the prior recommendation for \u201caggressive\u201d glycemic management\u003C\/p\u003E\n                  \u003C\/li\u003E\u003Cli id=\u0022list-item-48\u0022\u003E\n                     \u003Cp id=\u0022p-75\u0022\u003ENew recommendations for avoiding contrast-induced nephropathy\u003C\/p\u003E\n                  \u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-76\u0022\u003E\u201cGiven the rapid pace of change, it is even more important to keep abreast of the guidelines,\u201d said Dr. Giugliano.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/3\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn2xq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn2xq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}