Annals of Emergency Medicine
Volume 46, Issue 2 , Pages 185-197 , August 2005

Practical Implementation of the Guidelines for Unstable Angina/Non–ST-Segment Elevation Myocardial Infarction in the Emergency Department

References 

  1. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST-segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol. 2002;40(7):1366–1374
  2. Braunwald E, Mark DB, Jones RH, et al: Unstable Angina: Diagnosis and Management. Rockville, MD: Agency for Health Care Policy and Research and the National Heart Lung and Blood Institute, US Public Health Service, US Department of Health and Human Services. 1994:1. AHCPR publication No. 94-0602.
  3. Pollack CV, Gibler WB. 2000 ACC/AHA Guidelines for the management of Patients with Unstable Angina and Non-ST-segment Elevation Myocardial Infarction: a Practical Summary for Emergency Physicians. Ann Emerg Med. 2001;38:229–240
  4. Pollack CV, Roe MT, Peterson ED. 2002 Update to the ACC/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST-segment Elevation Myocardial Infarction: Implications for Emergency Department Practice. Ann Emerg Med. 2003;41:355–369
  5. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med. 2003;348:2635–2645
  6. Nourjah P. National Hospital Ambulatory Medical Care Survey: 1997 Emergency Department Summary. Hyattsville, MD: National Center for Health Statistics; 1999;304. Advance data from Vital and Health Statistics
  7. National Center for Health Statistics . Detailed Diagnosis and Procedures: National Hospital Discharge Survey, 1996. Hyattsville, MD: National Center for Health Statistics; 1998;13. Data from Vital and Health Statistics
  8. Savonitto S, Ardissino D, Granger CB, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA. 1999;281:707–713
  9. Apple FS, Wu AHB, Jaffe AS. European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: How to use existing assays clinically and for clinical trials. Am Heart J. 2002;144:981–986
  10. Jaffe AS, Ravkilde J, Roberts R, Naslund U, Apple FS, Galvani M, et al. It's Time for a Change to a Troponin Standard. Circulation. 2000;102:1216–1220
  11. Keidenreich PA, Alloggiamento T, Melsop K, et al. The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol. 2001;38:478–485
  12. Newby LK, Christenson RH, Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. The GUSTO IIa Investigators. Circulation. 1998;98:1853–1859
  13. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined - a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. JACC. 2000;36:959–969
  14. Novis DA, Jones BA, Dale JC, Walsh MK. Biochemical markers of myocardial injury test turnaround time. Arch Pathol Lab Med. 2004;128:158–164
  15. James SK, Lindahl B, Armstrong P, Califf R, Simoons ML, per Venge , et al. A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent events at suspicion of unstable coronary syndromes. International J Cardiol. 2003;93:113–120
  16. Aviles RJ, Askari AT, Lindahl B, Wallentin L, Jia G, Ohman EM, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med. 2002;346:2047–2052
  17. James S, Armstrong P, Califf R, Simoons ML, Venge P, Wallentin L, et al. Troponin T levels and risk of 30-day outcomes in patients with the acute coronary syndrome: prospective verification in the GUSTO-IV trial. Am J Med. 2003;115:178–184
  18. Panteghini M, Pagani F, Yeo KTJ, Apple FS, Christenson RH, Dati F, et al. Evaluation of the Imprecision at Low-Range Concentrations of the Assays for Cardiac Troponin Determination. Clin Chem. 2004;50:327–330
  19. Jaffe AS. Elevations in cardiac troponin measurements: False false-positives. Cardiovascular Toxicology. 2001;1(2):87–92
  20. Brennan ML, Penn MS, Van Lente F, et al. Prognostic Value of Myeloperoxidase in Patients with Chest Pain. N Engl J Med. 2003;249:1595–1604
  21. Wu AHB, Morris DL, Fletcher DR, et al. Analysis of the Albumin Cobalt Binding (ACB™) Test as an Adjunct to Cardiac Troponin I for the Early Detection of Acute Myocardial Infarction. Cardiovascular Tox. 2001;1:147–151
  22. Yusuf S, Collins R, MacMahon S, Peto R. Effect of intravenous nitrates on mortality in acute myocardial infarction; an overview of randomized trials. Lancet. 1988;1:1088–1092
  23. Armstrong P. Stable Ischemic Syndromes: Section 2: Clinical Cardiology (Califf RM, section ed). In:  Topol EJ editors. Textbook of Cardiovascular Medicine. Philadelphia, PA: Lippincott-Raven; 1998;p. 351–353
  24. White HD. Unstable Angina: Ischemic Syndromes. In:  Topol EJ editors. Textbook of Cardiovascular Medicine. Philadelphia, PA: Lippincott-Raven; 1998;p. 365–393
  25. Gibson RS, Boden WE, Theroux P, et al. Diltiazem and re-infarction in patients with non-Q-wave myocardial infarction. Results of a double-blind, randomized, multicenter trial. N Engl J Med. 1986;315:423–429
  26. Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT). Am J Cardiol. 1987;60:18A–25A
  27. ACE Inhibitor Myocardial Infarction Collaborative Group. Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. Circulation. 1998;97:2202–2212
  28. Flather M, Yusuf S, Kober L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left ventricular dysfunction: a systematic overview of data from individual patients. Lancet. 2000;355:1575–1581
  29. VALIANT Investigators . Valsartan in Acute Myocardial Infarction. Am Heart J. 2000;140:727–734Results presented, American Heart Association Scientific Sessions, November 2003. Orlando, Florida
  30. Yusuf S, Wittes J, Friedman L. Overview of the results of randomized clinical trials in heart disease, II. Unstable angina, heart failure, primary prevention with aspirin and risk factor modification. JAMA 1988;260:2259-2263.
  31. Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy-I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81–106
  32. The CURE Investigators . Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502
  33. Antman EM. Glycoprotein IIb/IIIa inhibitors in patients with unstable angina/non-ST-segment elevation myocardial infarction: Appropriate interpretation of the guidelines. Am Heart J. 2003;146:S18–S22
  34. Cannon CP, Weintraub WS, Demopoulos LA, et al. TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy) – Thrombolysis in Myocardial Infarction 18 Investigators. 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;344:1879–1887
  35. Boersma E, Akkerhuis KM, Theroux P, et al. Platelet glycoprotein IIb-IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation. 1999;100:2045–2048
  36. Kong DF, Califf RM, Miller DP, et al. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation. 1998;98:2829–2835
  37. The PURSUIT Trial Investigators . Inhibition of platelet glycoprotein IIb-IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med. 1998;339:436–443
  38. Simoons ML. GUSTO IV-ACS Investigators: Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularization: the GUSTO IV-ACS randomized trial. Lancet 2001;357:1915-1924.
  39. Lincoff AM. Direct thrombin inhibitors for non-ST-segment elevation acute coronary syndromes: What, when and where?. Am Heart J. 2003;146:S23–S30
  40. 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. JAMA. 1996;276:811–815
  41. Antman EM. Hirudin in acute myocardial infarction – thrombolysis and thrombin in myocardial infarction (TIMI) 9B trial. Circulation. 1996;94:911–921
  42. Antman EM, Cohen M, Radley D, et al. Assessment of the treatment effect of LMWH for unstable angina/non-Q-wave myocardial infarction. TIMI 11B-ESSENCE meta-analysis. Circulation. 1999;100:1602–1608
  43. Ferguson J, Califf R, Antman E, et al. 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
  44. Peterson JL, Mahaffey KW, Hasselblad V. 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
  45. Kleiman NS, Lincoff AM, Flaker GC, et al. Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. Circulation. 2000;101:751–757
  46. Allison JJ, Kiefe CI, Weissman NW, Person SD, Rousculp M, Canto JG, et al. Relationship of Hospital Teaching Status With Quality of Care and Mortality for Medicare Patients With Acute MI. JAMA. 2000;284:1256–1262
  47. Alexander KP, Peterson ED, Granger CB, et al. Potential impact of evidence-based medicine in acute coronary syndromes: insights from GUSTO IIb. Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes trial. J Am Coll Cardiol. 1998;32:2023–2030
  48. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PC, et al. Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA. 1999;282:1458–1465
  49. Califf RM, Faxon DP. Need for Centers to Care for Patients with Acute Coronary Syndromes. Circulation. 2003;107:1467–1470
  50. Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992;326:242–250
  51. Gibbons RJ, Smith S, Antman E. American College of Cardiology/American Heart Association Clinical Practice Guidelines: Part I Where Do They Come From?. Circulation. 2003;107:2979–2986
  52. Gibbons RJ, Smith SC, Antman E. American College of Cardiology/American Heart Association Clinical Practice Guidelines: Part II Evolutionary Changes in a Continuous Quality Improvement Project. Circulation. 2003;107:3101–3107
  53. Grili R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355:10306
  54. Hamm CW, Bertrand M, Braunwald E. Acute coronary syndrome without ST elevation: Implementation of new guidelines. Lancet. 2001;358:1533–1538
  55. Leape LL, Weissman JS, Schneider EC, Piana RN, Gatsonis C, Epstine AM. Adherence to practice guidelines: The role of specialty society guidelines. Am Heart J. 2003;145:19–26
  56. Boden WE, Pepine CJ. Introduction to ‘Optimizing Management of Non-ST-Segment Elevation Acute Coronary Syndromes’. J Am Coll Cardiol. 2003;41:1S–6S
  57. The Lipid Study Group . Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–1357
  58. Biviana AB, Rabbani LE, Paultre F, Hurley E, Sulivan J, Giglio J, et al. Usefulness of an Acute Coronary Syndrome Pathway to Improve Adherence to Secondary Prevention Guidelines. Am J Cardiol. 2003;91:1248–1250
  59. Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Faul J, et al. Improving Quality of Care for Acute Myocardial Infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA. 2002;287:1269–1276
  60. Fonarow GC, Gawlinski A, Moughrabi S, Tillisch JH. Improved Treatment of Coronary Heart Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001;87:819–822
  61. Fonarow GC, Gawlinski A. Rationale and Design of the Cardiac Hospitalization Atherosclerosis Management Program at the University of California Los Angeles. Am J Cardiol. 2000;85:10A–17A
  62. LaBresh KA, Ellrodt AG, Gliklich R, Liljestrand J, Peto R. Get With the Guidelines for Cardiovascular Secondary Prevention. Arch Intern Med. 2004;164:203–209
  63. Hoekstra J, Pollack C, Roe M, Peterson E, Brindis R, Harrington R, Christenson R, Smith S, Ohman M, and Gibler B. Improving the Care of Patients with Non-ST-Elevation Acute Coronary Syndromes in the Emergency Department: The CRUSADE Initiative. Acad Emerg Med 2002;9:1146–1155.
  64. Staman KL, Roe MR, Fraulo ES, Lytle BL, Gibler WB, Ohman EM, et al. Quality Improvement Tools Designed to Improve Adherence to the ACC/AHA Guidelines for the Care of Patients with Non-ST-Segment Acute Coronary Syndromes: The CRUSADE Quality Improvement Initiative. Critical Pathways in Cardiology. 2003;Vol. 2:No 1, 34-40

 The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 4, 2005. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0321. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 410-528-4121, fax 410-528-4264, or E-mail kgray@lww.com. To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400.This article is being reprinted in Annals of Emergency Medicine with permission.Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, vist http://www.americanheart.org/presenter.jhtml?identifier=3023366.

PII: S0196-0644(05)00540-8

doi: 10.1016/j.annemergmed.2005.04.022

Annals of Emergency Medicine
Volume 46, Issue 2 , Pages 185-197 , August 2005

Article Tools

* Image Usage & Resolution