You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 293 No. 3, January 19, 2005 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Clinical Review
 This Article
 •Full text
 •PDF
 •Correction
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (21)
 •Contact me when this article is cited
 Related Content
 •Related letters
 •Similar articles in JAMA
 Topic Collections
 •Nutritional and Metabolic Disorders
 •Lipids and Lipid Disorders
 •Cardiovascular System
 •Cardiovascular Disease/ Myocardial Infarction
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

CLINICIAN’S CORNER
A Simplified Approach to the Management of Non–ST-Segment Elevation Acute Coronary Syndromes

Ty J. Gluckman, MD; Molly Sachdev, MD, MPH; Steven P. Schulman, MD; Roger S. Blumenthal, MD

JAMA. 2005;293:349-357.

Context  While current practice guidelines provide an evidence-based approach to management of acute coronary syndromes (ACS), application of the evidence by individual physicians has been suboptimal.

Objective  To assess and synthesize the evidence regarding optimal management of non–ST-segment elevation ACS (NSTE-ACS).

Data Sources  Systematic searches of peer-reviewed publications were performed in MEDLINE and the Cochrane Database from January 1990 through November 2004, with consultation by content experts. Search terms included antiplatelet therapy, antithrombotic therapy, angiotensin-converting enzyme inhibition, angiotensin receptor blockade, {beta}-blockade, hypertension, hyperlipidemia, cigarette smoking, diet, diabetes mellitus, exercise, myocardial ischemia, and coronary artery disease.

Study Selection and Data Extraction  Criteria for selection of studies included controlled study design, English language, and clinical pertinence. Data quality was based on the publishing journal and relevance to clinical management of NSTE-ACS.

Data Synthesis  While outcomes of controlled studies support a comprehensive approach in the management of patients with NSTE-ACS, many physicians perceive existing guidelines as lengthy and complex. After risk stratification to identify those patients most likely to benefit from an early invasive vs early conservative strategy, a comprehensive management plan can be assembled through an "ABCDE" approach. The elements of this include "A" for antiplatelet therapy, anticoagulation, angiotensin-converting enzyme inhibition, and angiotensin receptor blockade; "B" for {beta}-blockade and blood pressure control; "C" for cholesterol treatment and cigarette smoking cessation; "D" for diabetes management and diet; and "E" for exercise.

Conclusion  An "ABCDE" approach for the management of NSTE-ACS provides a practical and systematic means to implement evidence-based medicine into clinical practice.


Author Affiliations: Division of Cardiology, the Johns Hopkins Hospital (Drs Gluckman, Sachdev, and Schulman) and Ciccarone Preventive Cardiology Center (Dr Blumenthal), Johns Hopkins University, Baltimore, Md.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

RELATED LETTERS

Use of Niacin During Non–ST-Segment Elevation Acute Coronary Syndromes
Mark R. Goldstein
JAMA. 2005;293(17):2092-2093.
EXTRACT | FULL TEXT  

Use of Niacin During Non–ST-Segment Elevation Acute Coronary Syndromes—Reply
Ty J. Gluckman, Molly Sachdev, Steven P. Schulman, and Roger S. Blumenthal
JAMA. 2005;293(17):2093.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

ACCF/AHA/ACP 2009 competence and training statement: a curriculum on prevention of cardiovascular disease.
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:1336-1363.
FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e100-e126.
FULL TEXT  

A Practical 'ABCDE' Approach to the Metabolic Syndrome
Blaha et al.
Mayo Clin Proc. 2008;83:932-943.
ABSTRACT | FULL TEXT  

Placing COURAGE in Context: Review of the Recent Literature on Managing Stable Coronary Artery Disease
Coylewright et al.
Mayo Clin Proc. 2008;83:799-805.
ABSTRACT | FULL TEXT  

Task Force 10: Training in Preventive Cardiovascular Medicine
Blumenthal et al.
J Am Coll Cardiol 2008;51:393-398.
FULL TEXT  

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Anderson et al.
J Am Coll Cardiol 2007;50:e1-e157.
FULL TEXT  

Can a Potent Statin Actually Regress Coronary Atherosclerosis?
Blumenthal and Kapur
JAMA 2006;295:1583-1584.
FULL TEXT  

Abciximab in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention After Clopidogrel Pretreatment: The ISAR-REACT 2 Randomized Trial
Kastrati et al.
JAMA 2006;295:1531-1538.
ABSTRACT | FULL TEXT  

The Year in Non--ST-Segment Elevation Acute Coronary Syndromes
Giugliano and Braunwald
J Am Coll Cardiol 2005;46:906-919.
FULL TEXT  

To Cath or Not to Cath: That Is No Longer the Question
Bhatt
JAMA 2005;293:2935-2937.
FULL TEXT  

Use of Niacin During Non-ST-Segment Elevation Acute Coronary Syndromes
Goldstein
JAMA 2005;293:2092-2093.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2005 American Medical Association. All Rights Reserved.