Should the emergence of new agents change the management of patients with acute coronary syndromes without ST-segment elevation?
Cardiac catheterization for diagnostic angiography and revascularization, if indicated, plays an increasing role in the management of acute coronary syndromes in the absence of ST elevation. The disagreement between those who favor a conservative approach to intervention and those who favor an aggressive approach centers on whether interventions should be routinely performed in all patients. New pharmacotherapies have emerged that reduce the incidence of death and myocardial infarction in this group of patients. At the same time, the success rate of percutaneous revascularizations has been improved by the widespread use of stenting, and a reduction in complications has been achieved with new pharmacologic agents. As therapies are rapidly evolving, it is difficult to extrapolate the results of earlier clinical trials to the most current practices. Until evidence is available comparing optimal medical management with the most successful interventional techniques, the best approach to intervention is likely to remain the subject of discussion.
Califf
R M
RM
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA.
Holmes
D R
DR
D000208:Acute Disease; D006328:Cardiac Catheterization; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013577:Syndrome
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors