American heart journal
-
American heart journal · Nov 2004
Randomized Controlled Trial Clinical TrialAcute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale.
Patients with acute coronary syndromes (ACS; unstable angina and non-ST-segment elevation myocardial infarction) are at significant risk for death and myocardial infarction. Early angiography followed by revascularization is considered the treatment of choice for moderate- to high-risk patients with ACS. However, despite the integration of newer therapies including stents, glycoprotein IIb/IIIa inhibitors, and thienopyridines, the rate of adverse ischemic events still remains unacceptably high, and the intensive pharmacologic regimens used to stabilize the disrupted atherosclerotic plaque and support angioplasty and surgical revascularization procedures elicit a high rate of bleeding complications. Pilot trials suggest that the thrombin-specific anticoagulant bivalirudin may improve clinical outcomes in ACS. ⋯ The ACUITY trial is the largest study yet performed in patients with ACS undergoing an invasive strategy. In addition to evaluating the utility of bivalirudin in ACS, this study will also provide important guidance regarding the necessity for and timing of IIb/IIIa inhibitor administration.
-
American heart journal · Nov 2004
Effect of age on the use of evidence-based therapies for acute myocardial infarction.
Previous studies have documented an underuse of evidence-based therapies in patients with acute myocardial infarction (AMI). However, many of these studies failed to consider contraindications to therapy, the effect of age (ie, elderly vs non-elderly patients) on use, or both. The objective of this study was to determine whether elderly patients are less likely than non-elderly patients to receive evidence-based AMI treatments, both before and after the consideration of contraindications to therapy. ⋯ Despite adjustments for contraindications to therapy, the underuse of AMI treatments, particularly in elderly patients, was found.
-
American heart journal · Nov 2004
Care of non-ST-segment elevation patients: insights from the CRUSADE national quality improvement initiative.
Acute coronary syndromes (ACS), including non-ST-segment elevation (NSTE) ACS, represent a significant source of morbidity and mortality in the United States. To address this widespread, serious health problem, the American College of Cardiology and the American Heart Association (ACC/AHA) published guidelines for the treatment of NSTE ACS, which include unstable angina (UA) and NSTE myocardial infarction (NSTEMI). These ACC/AHA guidelines are intended to help physicians make appropriate decisions when diagnosing and treating patients with NSTE ACS.