Noninvasive, medical management for non-ST-elevation acute coronary syndromes.
Despite emphasis on the use of invasive management strategies for patients with non-ST-elevation acute coronary syndromes (NSTE ACS) in recent practice guidelines, 27% to 56% of NSTE ACS patients do not undergo diagnostic angiography, and a further 45% to 78% do not undergo revascularization procedures during the initial hospitalization. These medically managed patients (also termed noninvasive management) have a greater frequency of medical comorbidities and high-risk clinical characteristics and are less likely to receive guideline-recommended medications, compared with patients who undergo revascularization procedures. The rates of short and long-term adverse outcomes are also substantially higher in medically managed NSTE ACS patients, but more widespread implementation of contemporary medical therapies in this population is limited by exclusion of medically managed patients from many randomized clinical trials.
Chan
Mark Y
MY
Duke Clinical Research Institute, Durham, NC 27705, USA. mark.chan@duke.edu
Becker
Richard C
RC
Harrington
Robert A
RA
Peterson
Eric D
ED
Armstrong
Paul W
PW
White
Harvey
H
Fox
Keith A A
KA
Ohman
E Magnus
EM
Roe
Matthew T
MT
D000208:Acute Disease; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D006801:Humans; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome