Table 1

Summary of ACC/AHA Guidelines Regarding Use of Aspirin, Statins, Beta-Blockers, and ACE Inhibitors

Aspirin
 STEMIAfter PCI, aspirin should be continued indefinitely (Class I, Level of Evidence: A)
 NSTEMIAspirin should be continued indefinitely. The maintenance dose should be 81 mg daily in patients treated with ticagrelor and 81 to 325 mg daily in all other patients (Class I, Level of Evidence: A)
 SIHDTreatment with aspirin 75 to 162 mg daily should be continued indefinitely in the absence of contraindications in patients with SIHD (Class I, Level of Evidence: A)
Statins
 STEMIHigh-intensity statin therapy should be initiated or continued in all patients with STEMI and no contraindications to its use (Class I, Level of Evidence: B)
 NSTEMIHigh-intensity statin therapy should be initiated or continued in all patients with NSTE-ACS and no contraindications to its use (Class I, Level of Evidence: B)
 SIHDIn addition to therapeutic lifestyle changes, a moderate or high dose of a statin therapy should be prescribed, in the absence of contraindications or documented adverse effects (Class I, Level of Evidence: A)
Beta-blocker therapy
 STEMIOral beta-blockers should be initiated in the first 24 h in patients with STEMI who do not have any of the following: signs of heart failure; evidence of a low output state; increased risk for cardiogenic shock; or other contraindications to use of oral beta-blockers (PR interval >0.24 s, second- or third-degree heart block, active asthma, or reactive airway disease) (Class I, Level of Evidence: B)
Beta-blockers should be continued during and after hospitalization for all patients with STEMI and with no contraindications to their use (Class I, Level of Evidence: B)
 NSTEMIOral beta-blocker therapy should be initiated within the first 24 h in patients who do not have any of the following: 1) signs of HF; 2) evidence of low-output state; 3) increased risk for cardiogenic shock; or 4) other contraindications to beta-blockade (e.g., PR interval >0.24 s, second- or third-degree heart block without a cardiac pacemaker, active asthma, or reactive airway disease) (Class I, Level of Evidence: A)
It is reasonable to continue beta-blocker therapy in patients with normal LV function with NSTE-ACS (Class IIa, Level of Evidence: C)
 SIHDBeta-blocker therapy should be started and continued for 3 yrs in all patients with normal LV function after MI or ACS (Class I, Level of Evidence: B)
Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <40%) with HF or previous MI, unless contraindicated (Class I, Level of Evidence: A)
Beta-blockers may be considered as long-term therapy for all other patients with coronary or other vascular disease (Class IIb, Level of Evidence: C)
ACE inhibitors
 STEMIAn ACE inhibitor should be administered within the first 24 h to all patients with STEMI with an anterior location, HF, or EF ≤40%, unless contraindicated (Class I, Level of Evidence: A)
ACE inhibitors are reasonable for all patients with STEMI and no contraindications to their use (Class IIa, Level of Evidence: A)
 NSTEMIACE inhibitors should be started and continued indefinitely in all patients with LVEF <0.40 and in those with hypertension, diabetes mellitus, or stable CKD, unless contraindicated (Class I, Level of Evidence: A)
ACE inhibitors may be reasonable in all other patients with cardiac or other vascular disease (Class IIb, Level of Evidence: C)
 SIHDACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LVEF ≤40%, or CKD, unless contraindicated (Class I, Level of Evidence: A)
Treatment with an ACE inhibitor is reasonable in patients with both SIHD and other vascular disease (Class IIa, Level of Evidence: B)

Each statement is presented with the class of recommendation and level of evidence in brackets.

ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; ACS = acute coronary syndrome; AHA = American Heart Association; CKD = chronic kidney disease; EF = ejection fraction; HF = heart failure; LV = left ventricle/ventricular; LVEF = left ventricular ejection fraction; MI = myocardial infarction; NSTE-ACS = non–ST-segment elevation acute coronary syndrome; NSTEMI = non–ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; SIHD = stable ischemic heart disease; STEMI = ST-segment elevation myocardial infarction.

  • Recommendations from O’Gara et al. (7), Fihn et al. (8), and Amsterdam et al. (9).