Non-ST segment elevation acute coronary syndromes: A simplified risk-oriented algorithm

Canadian Journal of Cardiology

Volumn 22, Issue 8, 2006, Pages 663-677

  Fitchett, David H ^a,b   Borgundvaag, Bjug ^c   Cantor, Warren ^d   Cohen, Eric ^e   Dhingra, Sanjay ^f   Fremes, Stephen ^e   Gupta, Milan ^g   Heffernan, Michael ^h   Kertland, Heather ^a   Husain, Mansoor ⁱ   Langer, Anatoly ^a,b   Letovsky, Eric ^j   Goodman, Shaun G ^a,b  

^a ST MICHAEL'S HOSPITAL   (Canada)

^b CANADIAN HEART RESEARCH CENTRE   (Canada)

^c MOUNT SINAI HOSPITAL   (Canada)

^d Southlake Hospital   (Canada)

^e SUNNYBROOK RESEARCH INSTITUTE   (Canada)

^f SCARBOROUGH HOSPITAL   (Canada)

^g William Osler Health Centre   (Canada)

^h Oakville Trafalgar Memorial Hospital   (Canada)

ⁱ UNIVERSITY HEALTH NETWORK   (Canada)

^j CREDIT VALLEY HOSPITAL   (Canada)

more..

Author keywords

Anticoagulants; Coronary disease; Myocardial infarction; Platelet aggregation inhibitors; Thrombosis

Indexed keywords

ABCIXIMAB; ACETYLSALICYLIC ACID; ANTITHROMBIN; ANTITHROMBOCYTIC AGENT; APROTININ; ATORVASTATIN; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CAPTOPRIL; CLOPIDOGREL; DALTEPARIN; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; ENOXAPARIN; EPTIFIBATIDE; FIBRINOGEN RECEPTOR ANTAGONIST; FONDAPARINUX; HEPARIN; HIRULOG; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LISINOPRIL; METOPROLOL; PERINDOPRIL; PRAVASTATIN; RAMIPRIL; SIMVASTATIN; TIROFIBAN; TRANDOLAPRIL; VALSARTAN;

ACUTE CORONARY SYNDROME; ALGORITHM; ANGIOCARDIOGRAPHY; ANTICOAGULANT THERAPY; ARTICLE; BLEEDING; CLINICAL TRIAL; DIAGNOSTIC PROCEDURE; DRUG EXCRETION; EUROPE; GASTROINTESTINAL HEMORRHAGE; GASTROINTESTINAL IRRITATION; HEALTH CARE ACCESS; HEALTH CARE COST; HEART CATHETERIZATION; HEART INFARCTION; HEART MUSCLE REVASCULARIZATION; HIGH RISK PATIENT; HOSPITALIZATION; HUMAN; META ANALYSIS; NORTH AMERICA; PRACTICE GUIDELINE; PROGNOSIS; RECURRENT DISEASE; RISK ASSESSMENT; SCORING SYSTEM; ST SEGMENT ELEVATION; SYSTEMATIC REVIEW; TREATMENT PLANNING; UNSTABLE ANGINA PECTORIS;

EID: 33746386841     PISSN: 0828282X     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0828-282X(06)70935-7     Document Type: Article

References (129)

1. Davies MJ. The contribution of thrombosis to the clinical expression of coronary atherosclerosis. Thromb Res 1996;82:1-32.
2. Davies MJ. Stability and instability: Two faces of coronary atherosclerosis. The Paul Dudley White Lecture 1995. Circulation 1996;94:2013-20.
3. DeWood MA, Stifter WF, Simpson CS et al. Coronary arteriographic findings soon after non-Q-wave myocardial infarction. N Engl J Med 1986;315:417-23.
4. Savonitto S, Ardissino D, Granger CB, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 1999;281:707-13.
5. Fitchett DH; University of Toronto Division of Cardiology and the Greater Toronto Area Community Cardiologists. Guidelines for the early management of acute coronary syndromes. Can J Cardiol 2000;16:1423-32.
6. Fitchett D, Goodman SG, Gupta M, Langer A. Preventing thrombosis: Update of first-line therapy in the management of non-ST segment elevation acute coronary syndromes. Can J Cardiol 2002;18:1179-90.
7. Braunwald E, Antman EM, Beasley JW, et al; American College of Cardiology; American Heart Association. Committee on the Management of Patients With Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction - summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366-74.
8. Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes: Acute coronary syndromes without persistent ST segment elevation; Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 2000;21:1406-32.
9. Segev A, Strauss BH, Tan M, Constance C, Langer A, Goodman SG; Canadian Acute Coronary Syndromes Registries Investigators. Predictors and 1-year outcome of major bleeding in patients with non-ST-elevation acute coronary syndromes: Insights from the Canadian Acute Coronary Syndrome Registries. Am Heart J 2005;150:690-4.
10. Rao SV, Jollis JG, Harrington RA, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004;292:1555-62.
11. Cohen M. Predictors of bleeding risk and long-term mortality in patients with acute coronary syndromes. Curr Med Res Opin 2005;21:439-45.
12. Granger CB, Steg PG, Peterson E, et al. Medication performance measures and mortality following acute coronary syndromes. Am J Med 2005;118:858-65.
13. Vikman S, Airaksinen KE, Tierala I, et al. Improved adherence to practice guidelines yields better outcome in high-risk patients with acute coronary syndrome without ST elevation: Findings from nationwide FINACS studies. J Intern Med 2004;256:316-23.
14. Eagle KA, Goodman SG, Avezum A, Budaj A, Sullivan CM, Lopez-Sendon J; GRACE Investigators. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: Findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 2002;359:373-7.
15. Fox KA, Goodman SG, Klein W, et al. Management of acute coronary syndromes. Variations in practice and outcome; Findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2002;23:1177-89.
16. Steg PG, Goldberg RJ, Gore JM, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol 2002;90:358-63.
17. Budaj A, Brieger D, Steg PG, et al; GRACE Investigators. Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2003;146:999-1006.
18. Bhatt DL, Roe MT, Peterson ED, et al; CRUSADE Investigators. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. JAMA 2004;292:2096-104.
19. Granger CB, Goldberg RJ, Dabbous O, et al; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Inter Med 2003;163:2345-53.
20. Goldstein JA, Demetriou D, Grines OL, Pica M, Shoukfeh M, O'Neill WW. Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med 2000;343:915-22.
21. Brieger D, Eagle KA, Goodman SG, et al; GRACE Investigators. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from the Global Registry of Acute Coronary Events. Chest 2004;126:461-9.
22. Berger A, Meier JM, Stauffer JC, et al. ECG interpretation during the acute phase of coronary syndromes: In need of improvement? Swiss Med Wkly 2004;134:695-9.
23. Henrikson CA, Howell EE, Bush DE, et al. Prognostic usefulness of marginal troponin T elevation. Am J Cardiol 2004;93:275-9.
24. Kaul P, Newby LK, Fu Y, et al; PARAGON-B Investigators. Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndrome patients. J Am Coll Cardiol 2003;41:371-80.
25. Lindahl B, Diderholm E, Lagerqvist B, Venge P, Wallentin L; FRISC II (Fast Revascularization during InStability in CAD) Investigators. Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: A FRISC II substudy. J Am Coll Cardiol 2001;38:979-86.
26. Khan IA, Tun A, Wattanasauwan N, et al. Elevation of serum cardiac troponin I in noncardiac and cardiac diseases other than acute coronary syndromes. Am J Emerg Med 1999;17:225-9.
27. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndrome without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation 2000;101:2557-67.
28. Eagle KA, Lim MJ, Dabbous OH, et al; GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291:2727-33.
29. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000;284:835-42.
30. Granger CB, Goldberg RJ, Dabbous O, et al; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Inter Med 2003;163:2345-53.
31. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291:2727-33.
32. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291:2727-33.
33. Sanchez PL, Morinigo JL, Pabon P, et al. Prognostic relations between inflammatory markers and mortality in diabetic patients with non-ST elevation acute coronary syndrome. Heart 2004;90:264-9.
34. Zimmerman D, Fromm R, Meyer D, et al. Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation 1999;99:1671-7.
35. Farkouh ME, Smars PA, Reeder GS, et al. A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med 1998;339:1882-8.
36. Choudhry NK, Singh JM, Barolet A, et al. How should patients with unstable angina and non-ST-segment elevation myocardial infarction be managed? A meta-analysis of randomized trials. Am J Med 2005;118:465-74.
37. Mehta SR, Cannon CP, Fox KA, et al. Routine versus selective invasive strategies in patients with acute coronary syndromes. JAMA 2005;293:2908-17.
38. Biondi-Zoccai GG, Abbate A, Agostoni P, et al. Long-term benefits of an early invasive management in acute coronary syndromes depend on intracoronary stenting and aggressive antiplatelet treatment: A metaregression. Am Heart J 2005;149:504-11.
39. Bavry AA, Kumbhani DJ, Quiroz R, et al. Invasive therapy along with glycoprotein IIb/IIIa inhibitors and intracoronary stents improves survival in non-ST-segment elevation acute coronary syndromes: A meta-analysis and review of the literature. Am J Cardiol 2004;93:830-5.
40. Cannon CP, Weintraub WS, Demopoulos L, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001;344:1879-87.
41. Solomon DH, Stone PH, Glynn RJ, et al. Use of risk stratification to identify patients with unstable angina likeliest to benefit from an invasive versus conservative management strategy. J Am Coll Cardiol 2001;38:969-76.
42. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Lancet 1999;354:708-15.
43. Spacek R, Widimsky P, Straka Z, et al. Value of first day angiography/ angioplasty in evolving non-ST segment elevation myocardial infarction: An open multicenter randomized trial. Eur Heart J 2002;23:230-8.
44. Fox KA, Poole-Wilson P, Henderson RA, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST segment elevation myocardial infarction: The British Heart Foundation Randomised RITA 3 Trial. Lancet 2002;360:743-51.
45. The TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Results of the TIMI IIIB Trial. Thrombolysis in Myocardial Ischemia. Circulation 1994;89:1545-56.
46. Boden WE, O'Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med 1998;338:1785-92.
47. McCullough PA, O'Neill WW, Graham M, et al. A prospective randomized trial of triage angiography in acute coronary syndromes ineligble for thrombolytic therapy. Results of the medicine versus angiography in thrombolytic exclusion (MATE) Trial. J Am Coll Cardiol 1998;32:596-605.
48. De Winter RJ, Windhausen F, Cornel JH, et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med 2005;353:1095-104.
49. Cannon CP, Weintraub WS, Demopoulos LA, Robertson DH, Gormley GJ, Braunwald E. Invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction following treatment with tirofiban: Rationale and study design of the international TACTICS-TIMI 18 Trial. Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy. Thrombolysis In Myocardial Infarction. Am J Cardiol 1998;82:731-6.
50. Fox KA, Poole-Wilson P, Clayton TC, et al. Five-year outcome of an interventional strategy in non-ST elevation acute coronary syndromes. The British Heart Foundation RITA-3 randomised trial. Lancet 2005;366:914-20.
51. Cantor WJ, Goodman SG, Cannon CP, et al. Early cardiac catheterization is associated with lower mortality only among high-risk patients with ST and non-ST-elevation acute coronary syndromes: Observations from the OPUS-TIMI 16 trial. Am Heart J 2005;149:275-83.
52. Bhatt DL, Roe MT, Peterson ED, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. JAMA 2004;292:2096-2104.
53. Neumann FJ, Kastrati A, Pogatsa-Murray G, et al. Evaluation of prolonged antithrombotic pretreatment ("cooling-off" strategy) before intervention in patients with unstable coronary syndromes: A randomized controlled trial. JAMA 2003;290:1593-9.
54. O'Neill BJ, Brophy JM, Simpson CS, et al. Treating the right patient at the right time: Access to care in non-ST segment elevation acute coronary syndromes. Can J Cardiol 2005;21:1149-55.
55. Cairns J, Gent M, Singer J, et al. Aspirin, sulphinpyrazone or both in unstable angina: Results of a Canadian Multicentre Trial. N Engl J Med 1985;313:1369-75.
56. Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin or both to treat acute unstable angina. N Engl J Med 1988;319:1105-111.
57. Peters RJ, Mehta SR, Fox KA, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003;108:1682-7.
58. Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA. Aspirin sensitivity: Implications for patients with coronary artery disease. JAMA 2004;292:3017-23.
59. Silberman S, Neukirch-Stoop C, Steg PG. Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol 2005;95:509-10.
60. Sanderson S, Emery J, Baglin T, Kinmonth AL. Narrative review: Aspirin resistance and its clinical implications. Ann Intern Med 2005;370-80.
61. Mehta SR, Yusuf S; Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Study Investigators. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme; Rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur Heart J 2000;21:2033-41.
62. Budaj A, Yusuf S, Mehta SR, et al. Benefit of clopidogrel in patients with acute coronary syndromes without ST segment elevation in various risk groups. Circulation 2002;106:1622-6.
63. Chu MW, Wilson SR, Novick RJ, et al. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg 2004;78:1536-41.
64. Fox KA, Mehta SR, Peters R, et al; Clopidogrel in Unstable angina to prevent Recurrent ischemic Events Trial. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: The Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation 2004;110:1202-128.
65. Sadanandan S, Cannon CF, Gibson CM, et al. A risk score to estimate the likelihood of coronary artery bypass surgery during the index hospitalization among patients with unstable angina and non-ST-segment elevation myocardial infarction. J Am Coll Cardiol 2004;44:799-803.
66. van der Linden J, Lindvall G, Sartipy U. Aprotinin decreases postoperative bleeding and number of transfusions in patients on clopidogrel undergoing coronary artery bypass graft surgery: A double-blind, placebo-controlled, randomized clinical trial. Circulation 2005;112(Suppl 9):I276-80.
67. Lindvall G, Sartipy U, van der LJ. Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting. Ann Thorac Surg 2005;80:922-97.
68. Akowuah E, Shrivastava V, Jamnadas B, et al. Comparison of two strategies for the management of antiplatelet therapy during urgent surgery. Ann Thorac Surg 2005;80:149-52.
69. Mangano DT, Tudor I, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery. N Engl J Med 2006;354:353-65.
70. Nguyen TA, Diodati JG, Pharand C. Resistance to clopidogrel: A review of the evidence. J Am Coll Cardiol 2005;45:1157-64.
71. Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 2004;109:3171-5.
72. Montelescot G; the ALBION Investigators. Assessment of the best loading dose of clopidogrel to blunt platelet activation, inflammation and ongoing necrosis. Eur Heart J 2005;26:484.
73. Patti G, Colonna G, Pasceri V, et al. A randomized trial of high loading dose of clopidogrel for reduction of peri-procedural myocardial infarction in patients undergoing coronary intervention. Eur Heart J 2005;26:39.
74. Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/ IIIa inhibitors in acute coronary syndromes: A meta-analysis of all major randomised clinical trials. Lancet 2002;359:189-98.
75. Simoons ML. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: The GUSTO IV-ACS randomised trial. Lancet 2001;357:1915-24.
76. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. N Engl J Med 1998;338:1488-97.
77. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators. N Engl J Med 1998;338:1498-505.
78. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med 1998;339:436-43.
79. Pieper KS, Tsiatis AA, Davidian M, et al. Differential treatment benefit of platelet glycoprotein IIb/IIIa inhibition with percutaneous coronary intervention versus medical therapy for acute coronary syndromes: Exploration of methods. Circulation 2004;109:641-6.
80. Heeschen C, Hamm CW, Goldmann B, et al. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet Receptor Inhibition in Ischemic Syndrome Management. Lancet 1999;354:1757-62.
81. Newby LK, Ohman EM, Christenson RH, et al. Benefit of glycoprotein IIb/ IIIa inhibition in patients with acute coronary syndromes and troponin T positive status. Circulation 2001;103:2891-6.
82. Roffi M, Chew DP, Mukherjee D, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST segement elevation acute coronary syndromes. Circulation 2001;104:2767-71.
83. Hoekstra JW, Roe MT, Peterson ED, et al. Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: Patient selection and associated treatment patterns. Acad Emerg Med 2005;12:431-8.
84. Peterson ED, Pollack CV, Roe MT, et al; National Registry of Myocardial Infarction (NRMI) 4 Investigators. Early use of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction: Observations from the National Registry of Myocardial Infarction 4. J Am Coll Cardiol 2003;42:45-53.
85. Goodman SG, Fitchett D, Tan M et al. Management of acute coronary syndromes (ACS) in Canada: Anti-platelet/thrombotic therapy in the first 24 hours. Can J Cardiol 2001;17:228C.
86. Dalby M, Montalescot G, Bal dit Sollier C, et al. Eptifibatide provides additional platelet inhibition in non-ST-elevation myocardial infarction patients already treated with aspirin and clopidogrel. Results of the platelet activity extinction in non-Q-wave myocardial infarction with aspirin, clopidogrel, and eptifibatide (PEACE) study. J Am Coll Cardiol 2004;43:162-8.
87. Kastrati A, Mehilli J, Neumann FJ, et al; Intracoronary Stenting and Antithrombotic: Regimen Rapid Early Action for Coronary Treatment 2 (ISAR-REACT 2) Trial Investigators. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: The ISAR-REACT 2 randomized trial. JAMA 2006;295:1531-8.
88. Giugliano RP, Newby LK, Harrington RA, et al; EARLY ACS Steering Committee. The early glycoprotein IIb/IIIa inhibition in non-ST-segment elevation acute coronary syndrome (EARLY ACS) trial: A randomized placebo-controlled trial evaluating the clinical benefits of early front-loaded eptifibatide in the treatment of patients with non-ST-segment elevation acute coronary syndrome - Study design and rationale. Am Heart J 2005;149:994-1002.
89. Oler A, Whooley MA, Oler J, et al. Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. A meta-analysis. JAMA 1996;276:811-5.
90. Peterson JL, Mahaffey KW, Hasselblad V, et al. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: A systematic overview. JAMA 2004;292:89-96.
91. Ferguson JJ, Califf RM, Antman EM, et al; SYNERGY Trial Investigators. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: Primary results of the SYNERGY randomized trial. JAMA 2004;292:45-54.
92. Goodman SG, Fitchett DH, Armstrong P, et al. Randomized evalutation of the safety and efficacy of enoxaparin versus unfractionated heparin in high risk patients with non ST segment elevation acute coronary syndromes receiving the GP IIb/IIIa receptor inhibitor eptifibatide. Circulation 2003;107:238-44.
93. Collet JP, Montalescot G, Golmard JL, et al. Subcutaneous enoxaparin with early invasive strategy in patient with acute coronary syndromes. Am Heart J 2004;147:655-61.
94. Fitchett D, Welsh R, Langer A, et al. Enoxaparin and percutaneous coronary intervention: A Canadian perspective. Can J Cardiol 2005;21:501-7.
95. Yusuf S, Mehta SR, Chrolavicius S, et al; Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006;354:1464-76.
96. Moscucci M, Fox KA, Cannon CP, et al. Predictors of major bleeding in acute coronary syndromes: The Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24:1815-23.
97. Sinnaeve PR, Simes J, Yusuf S, et al. Direct thrombin inhibitors in acute coronary syndromes: Effect in patients undergoing early percutaneous coronary intervention. Eur Heart J 2005;26:2396-403.
98. Lincoff AM, Kleiman NS, Kereiakes DJ, et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA 2004;292:696-703.
99. Stone GW, Bertrand M, Colombo A et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: Study design and rationale. Am Heart J 2004;148:764-75.
100. Yusuf S, Peto R, Lewis J, et al. Beta-blockade during and after myocardial infarction: An overview of the randomised trials. Prog Cardiovasc Dis 1985;27:335-71.
101. Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta Blockade after myocardial infarction: Systematic review and meta regression analysis. BMJ 1999;318:1730-7.
102. Chen ZM, Pan HC, Chen YP, et al; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: Randomised placebo-controlled trial. Lancet 2005;366:1622-32.
103. Flather MD, Lonn EM, Yusuf S. Effects of ACE inhibitors on mortality when started in the early phase of myocardial infarction: Evidence from the larger randomized controlled trials. J Cardiovasc Risk 1995;2:423-8.
104. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.
105. Massoudi FA, Plomondon ME, Magid DJ, et al. Renal insufficiency and mortality from acute coronary syndromes. Am Heart J 2004;147:623-9.
106. Halon DA, Adawi S, Dobrecky-Mery IK, et al. Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients. J Am Coll Cardiol 2004;43:346-52.
107. Steg PG, Dabbous OF, Feldman LJ, et al. Determinants and prognostic impact of heart failure complicating acute coronary syndromes: Observations from the Global Registry of Acute Coronary Syndromes (GRACE). Circulation 2004;109:494-9.
108. Ohman EM, Roe MT, Peterson ED, et al. Care of non-ST-segment elevation patients: Insight from the CRUSADE national quality improvement initiative. Am Heart J 2004;148:S34-9.
109. Alexander KP, Chen AY, Roe MT, et al; CRUSADE Investigators. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA 2005;294:3108-16.
110. Bartnick M, Malmberg K, Norhammar A, et al. Newly detected abnormal glucose tolerance: An important predictor of long-term outcome after myocardial infarction. Eur Heart J 2004;25:1990-7.
111. Bartnik M, Malmberg K, Hamsten A, et al. Abnormal glucose tolerance - A common risk factor in patients with acute myocardial infarction in comparison with population-based controls. J Intern Med 2004;256:288-97.
112. Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: The MIRACL study: A randomized controlled trial. JAMA 2001;285:1711-8.
113. Cannon CP, Braunwald E, McCabe CH, et al; PROVE IT-TIMI 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350:1495-504.
114. Ray KK, Cannon CP, McCabe CH, et al. Early and late benfits of high-dose atorvastatin in patients with acute coronary syndromes. Results from the PROVE IT-TIMI 22 Trial. J Am Coll Cardiol 2005;46:1405-10.
115. de Lemos J, Blazing MA, Wiviott SD, et al; A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: Phase Z of the A to Z trial. JAMA 2004;292:1307-16.
116. Pedersen TR, Faergeman O, Kastelein JJ, et al; Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: A randomized controlled trial. JAMA 2005;294:2437-45. (Erratum in 2005;294:3092).
117. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53.
118. Fox KM; EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362:782-8.
119. Braunwald E, Domanski MJ, Fowler SE, et al; PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004;351:2058-68.
120. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 1992;327:669-77.
121. Bhatt DL, Fox KA, Hacke W, et al; CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006;354:1706-17.
122. Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: An overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335-71.
123. Goodman SG, Tan M, Spindler C, et al. Coronary angiography and revascularization in acute coronary syndromes (ACS): What the Canadian ACS Registry reveals about "real world" management during index hospitalization. Can J Cardiol 2001;17:228C.
124. Fox KA, Goodman SG, Klein W, et al. Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2002;23:1177-89.
125. Granger CB, Steg PG, Peterson E, et al. Medication performance measures and mortality following acute coronary syndromes. Am J Med 2005;118:858-65.
126. Anderson HV, Shaw RE, Brindis RG, et al. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force Guidelines. Circulation 2005;105:2786-91.
127. Granger CB, Steg PG, Peterson E, et al. Medication performance measures and mortality following acute coronary syndromes. Am J Med 2005;118:858-65.
128. Peterson ED, Roe MT, Lytle BL, et al. The association between care and outcomes in patients with acute coronary syndrome: National results from CRUSADE. J Am Coll Cardiol 2004;43(Suppl 2):406A.
129. Theroux P. Acute Coronary Syndromes: A Companion to Braunwald's Heart Disease. WB Saunders Co: Philadelphia, 2003:168-86.