title: Non ST segment elevation acute coronary syndromes: A simplified risk-orientated algorithm.
abstract: Non-ST segment elevation acute coronary syndromes (NSTE ACS) include a clinical spectrum that ranges from unstable angina to NSTE myocardial infarction. Management goals aim to prevent recurrent ACS and improve long-term outcomes by choosing a treatment strategy according to an estimate of the risk of an adverse outcome. Recent registry data suggest that patients with NSTE ACS frequently do not receive recommended treatment, and that risk stratification is not used to determine either the choice of treatment or the speed of access to coronary angiography. The present article evaluates the evidence for recommended treatment using information from recent trials and guidelines published by the major cardiac organizations in Europe and North America. Using this information, a multidisciplinary group developed a simplified algorithm that uses risk stratification to select an optimal early management strategy. Long-term outcomes are improved by a multi-faceted vascular protection strategy that is initiated at the time of hospitalization for NSTE ACS.
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada. fitchettd@smh.toronto.on.ca
authors.forename: David H
authors.initials: DH
authors.lastname: Fitchett
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.forename: Warren
authors.initials: W
authors.lastname: Cantor
authors.forename: Eric
authors.initials: E
authors.lastname: Cohen
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dhingra
authors.forename: Stephen
authors.initials: S
authors.lastname: Fremes
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.forename: Michael
authors.initials: M
authors.lastname: Heffernan
authors.forename: Heather
authors.initials: H
authors.lastname: Kertland
authors.forename: Mansoor
authors.initials: M
authors.lastname: Husain
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Eric
authors.initials: E
authors.lastname: Letovsky
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors