A Simplified Approach to the Management of Non–ST-Segment Elevation Acute Coronary Syndromes
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TLDR
An "ABCDE" approach for the management of NSTE-ACS provides a practical and systematic means to implement evidence-based medicine into clinical practice.Abstract:
ContextWhile current practice guidelines provide an evidence-based approach
to management of acute coronary syndromes (ACS), application of the evidence
by individual physicians has been suboptimal.ObjectiveTo assess and synthesize the evidence regarding optimal management of
non–ST-segment elevation ACS (NSTE-ACS).Data SourcesSystematic searches of peer-reviewed publications were performed in
MEDLINE and the Cochrane Database from January 1990 through November 2004,
with consultation by content experts. Search terms included antiplatelet therapy, antithrombotic therapy, angiotensin-converting enzyme inhibition, angiotensin receptor blockade, β-blockade, hypertension, hyperlipidemia, cigarette smoking, diet, diabetes mellitus, exercise, myocardial ischemia, and coronary artery
disease.Study Selection and Data ExtractionCriteria for selection of studies included controlled study design,
English language, and clinical pertinence. Data quality was based on the publishing
journal and relevance to clinical management of NSTE-ACS.Data SynthesisWhile outcomes of controlled studies support a comprehensive approach
in the management of patients with NSTE-ACS, many physicians perceive existing
guidelines as lengthy and complex. After risk stratification to identify those
patients most likely to benefit from an early invasive vs early conservative
strategy, a comprehensive management plan can be assembled through an “ABCDE”
approach. The elements of this include “A” for antiplatelet therapy,
anticoagulation, angiotensin-converting enzyme inhibition, and angiotensin
receptor blockade; “B” for β-blockade and blood pressure
control; “C” for cholesterol treatment and cigarette smoking cessation;
“D” for diabetes management and diet; and “E” for
exercise.ConclusionAn “ABCDE” approach for the management of NSTE-ACS provides
a practical and systematic means to implement evidence-based medicine into
clinical practice.read more
Citations
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Journal ArticleDOI
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Ezra A. Amsterdam,Nanette K. Wenger,Ralph G. Brindis,Donald E. Casey,Theodore G. Ganiats,David R. Holmes,Allan S. Jaffe,Hani Jneid,Rosemary F. Kelly,Michael C. Kontos,Glenn N. Levine,Philip R. Liebson,Debabrata Mukherjee,Eric D. Peterson,Marc S. Sabatine,Richard W. Smalling,Susan J. Zieman +16 more
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Journal ArticleDOI
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)...
Jeffrey L. Anderson,Cynthia D. Adams,Elliott M. Antman,Charles R. Bridges,Robert M. Califf,Donald E. Casey,William E. Chavey,Francis M. Fesmire,Judith S. Hochman,Thomas N. Levin,A. Michael Lincoff,Eric D. Peterson,Pierre Theroux,Nanette K. Wenger,R. Scott Wright,Sidney C. Smith,Alice K. Jacobs,Jonathan L. Halperin,Sharon A. Hunt,Harlan M. Krumholz,Frederick G. Kushner,Bruce W. Lytle,Rick A. Nishimura,Joseph P. Ornato,Richard L. Page,Barbara Riegel +25 more
TL;DR: Angina/Non-ST-Elevation Myocardial Infarction : ACC/AHA 2007 Guidelines for the Management of Patients With Unstable ISSN: 1524-4539 Copyright © 2007 American Heart Association.
Journal ArticleDOI
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary
Ezra A. Amsterdam,Nanette K. Wenger,Ralph G. Brindis,Donald E. Casey,Theodore G. Ganiats,David R. Holmes,Allan S. Jaffe,Hani Jneid,Rosemary F. Kelly,Michael C. Kontos,Glenn N. Levine,Philip R. Liebson,Debabrata Mukherjee,Eric D. Peterson,Marc S. Sabatine,Richard W. Smalling,Susan J. Zieman +16 more
TL;DR: In this paper, early hospital care, hospital discharge, and post-hospital discharge care are recommended for Acs, based on myocardial revascularization and initial evaluation and management.
Journal ArticleDOI
2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines
Jeffrey L. Anderson,Cynthia D. Adams,Elliott M. Antman,Charles R. Bridges,Robert M. Califf,Donald E. Casey,William E. Chavey,Francis M. Fesmire,Judith S. Hochman,Thomas N. Levin,A. Michael Lincoff,Eric D. Peterson,Pierre Theroux,Nanette K. Wenger,R. Scott Wright,Hani Jneid,Steven M. Ettinger,Theodore G. Ganiats,George J. Philippides,Alice K. Jacobs,Jonathan L. Halperin,Nancy M. Albert,Mark A. Creager,David L. DeMets,Robert A. Guyton,Frederick G. Kushner,E. Magnus Ohman,William G. Stevenson,Clyde W. Yancy +28 more
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Journal ArticleDOI
Abciximab in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention After Clopidogrel Pretreatment: The ISAR-REACT 2 Randomized Trial
Adnan Kastrati,Julinda Mehilli,Franz-Josef Neumann,Franz Dotzer,Jurriën M. ten Berg,Hildegard Bollwein,Isolde Graf,Maryam Ibrahim,Jürgen Pache,Melchior Seyfarth,Helmut Schühlen,Josef Dirschinger,Peter B. Berger,Albert Schömig,Antithrombotic Regimen: Rapid Early Action for Coronary Treatment Trial Investigators +14 more
TL;DR: In this paper, the role of the glycoprotein IIb/IIIa inhibitor abciximab in patients with non-ST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after pretreatment with 600 mg of clopidogrel.
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