Acute coronary syndrome without ST elevation: implementation of new guidelines.
Unstable angina and non-ST-segment-elevation myocardial infarction have in recent years been recognised as frequent and important clinical manifestations of coronary-artery disease. The European (ESC) and American (ACC/AHA) professional societies last year released guidelines on diagnosis, risk stratification, and treatment of these disorders. These guidelines summarise similarly the current evidence and translate them to clinical practice. Most important changes relate to the inclusion of troponins into the risk stratification algorithm, the addition of low-molecular-weight heparin and glycoprotein IIb/IIIa antagonists to medical treatment, and the role of invasive management for improved long-term outcome. Guidelines are constantly challenged by newly emerging study results. Recently, early invasive management and clopidogrel have been found to exert further benefit to this high-risk group of patients. Accordingly, the societies on both sides of the Atlantic will work together closely to update and implement these guidelines.
Hamm
C W
CW
Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, D-61231 Bad Nauheim, Germany. Christian.Hamm@kerckhoff.med.uni-giessen.de
Bertrand
M
M
Braunwald
E
E
D000077284:Abciximab; D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy; D004562:Electrocardiography; D005060:Europe; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D000077466:Tirofiban; D014336:Troponin / Q000378:metabolism; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014481:United States
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D014443:Tyrosine; D000077466:Tirofiban; D000077284:Abciximab