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(Circulation. 2004;109:698-700.)
© 2004 American Heart Association, Inc.

Focused Perspective

We Must Use the Knowledge That We Have to Treat Patients With Acute Coronary Syndromes

Harvey D. White, DSc, FRACP; James T. Willerson, MD

From the Auckland City Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand (H.D.W.), and Department of Cardiology, St Luke’s Episcopal Hospital/Texas Heart Institute, Houston, Tex (J.T.W.).

Correspondence to Dr Harvey D. White, Cardiology Department, Auckland City Hospital, Private Bag 92024, Auckland 1030, NZ. E-mail harveyw@adhb.govt.nz

Key Words: Focused Perspectives • coronary disease • trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Numerous registries have shown that evidence-based therapies are often not prescribed despite strong evidence that they reduce mortality and morbidity.¹ In this edition of the journal, Mukherjee et al² describe the use of a composite appropriateness score to assess the potential effect of evidence-based therapies on 6-month mortality in 1358 consecutive patients presenting with an acute coronary syndrome (ACS). Fifteen percent of these patients had ST-elevation myocardial infarction (MI), 55% had non–ST-elevation MI, and 30% had unstable angina. Most were in Killip class I or II, and 48% underwent either percutaneous coronary intervention or coronary artery bypass grafting while in the hospital. The study found that the use of antiplatelet therapy, statins, angiotensin-converting enzyme (ACE) inhibitors, and ß-blockers had apparently additive effects in reducing 6-month mortality. There was also a strong trend (P=0.08) toward increased survival in patients who underwent revascularization procedures—a finding consistent with the results of the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC-II) study in patients with non–ST-elevation ACS treated for 5 to 7 days with the low molecular weight heparin, dalteparin.³

See p 745

Mukherjee et al¹ report that the odds ratio for 6-month mortality was reduced to 0.10 (95% CI, 0.03 to 0.42; P<0.0001) by the use of all indicated therapies versus none, 0.17 (95% CI, 0.04 to 0.75; P=0.0013) by the use of 3 indicated therapies, 0.18 (95% CI, 0.04 to 0.77; P=0.01) by the use of 2 indicated therapies, and 0.36 (95% CI, 0.08 . . . [Full Text of this Article]

Related Article:

Impact of Combination Evidence-Based Medical Therapy on Mortality in Patients With Acute Coronary Syndromes

Debabrata Mukherjee, Jianming Fang, Stanley Chetcuti, Mauro Moscucci, Eva Kline-Rogers, and Kim A. Eagle
Circulation 2004 109: 745-749. [Abstract] [Full Text]

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