Clinical Question: What is the opti...

Clinical Question: What is the optimal management of non-ST-segment elevation acute coronary syndrome?

Setting: Various (meta-analysis)

cogitation Design: Meta-analysis (randomized controlled trials)

Synopsis: Although practice guidelines abound onward the best treatment of acute coronary syndrome a simplified order for applying the best evidence would help many physicians. In this meta-analysis, the authors searched standard evidence-based sources, including the Cochrane database and MED-LINE, for controll studies in succession the treatment of non-ST-segment elevation acute coronary syndrome No information was given onward the independent assessment of review and evaluation or the potential for publication bias, nevertheless the authors discussed the toughness of evidence for their have a title to recommendations. To simplify the recommendations, they summarized them with an ABCDE acronym, as follows:

A: Antiplatelet therapy, including aspirin for all patients indefinitely, initially with 162 mg to 325 mg followed at 75 mg to 160 mg daily thereafter; clopidogrel for all patients unles physicians anticipate a ne for pertinacious coronary artery bypass grafting surgery for up to single in kind year; and Gp IIb/IIIa inhibitor therapy for all patients with continuing ischemia, an elevated troponin flat a Thrombolysis in Myocardial Infarction proceed grade greater than 4, or anticipated percutaneous coronary intervention. Anticoagulation, including low-molecular-weight heparin or unfractionated heparin unles creatinine clearance is les than 60 mL by minute, or coronary artery bypass grafting surgery was performed within 24 hours. Angiotensin-converting enzyme inhibition or androgen receptor blockade for all patients with left ventricular dysfunction (i.e., ejection fraction of 40 percent or less) heart failure, or hypertension.

B: Beta blockade for all patients and offspring pressure control, with a goal of 130/85 mm Hg or less

C: Cholesterol treatment for all patients with a low-density lipoprotein goal of les than 70 mg by dL (1.80 mmol per L) and cigarette smoking cessation.

D: Diabetes management and diet (the Mediterranean diet, in particular).

E: Exercise, preferably with a cardiac rehabilitation program.

Bottom Line: The ABCDE approach can forward as a guide for applying the best evidence in the care of patients with non-ST-segment elevation acute coronary syndrome ABCDE stands for Antiplatelet, Anticoagulation, and Angiotensin-converting enzyme inhibition; Beta blockade and progeny pressure control; Cholesterol treatment and Cigarette smoking cessation; Diabetes management and Diet; and Exercise. The acronym, although easy to remember, does not intend to rank the interventions in period of times of their relative benefit. (Level of Evidence: 1a)

consideration Reference: Gluckman TJ, et al. A simplified approach to the management of non-ST-segment elevation acute coronary syndrome JAMA January 19 2005;293:349-57

Used with permission from Slawson D ABCDE approach to non-ST-segment elevation ACS. Accessed online March 1 2005 at: http://www.InfoPOEMs.com.

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