Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification
Identifieur interne : 003524 ( PascalFrancis/Checkpoint ); précédent : 003523; suivant : 003525Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification
Auteurs : Gustavo B. F. Oliveira [Brésil] ; Alvaro Avezum [Brésil] ; Frederick A. Jr Anderson [États-Unis] ; Andrzej Budaj [Pologne] ; Omar H. Dabbous [États-Unis] ; Shaun G. Goodman [Canada] ; Philippe Gabriel Steg [France] ; Robert J. Goldberg [États-Unis] ; David Brieger [Australie] ; Keith A. A. Fox [Royaume-Uni] ; Joel M. Gore [États-Unis] ; Christopher B. Granger [États-Unis]Source :
- The American heart journal [ 0002-8703 ] ; 2007.
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Abstract
Background Current guidelines advise the use of risk stratification to determine which'patients should receive more aggressive antithrombotic and invasive therapies. Our objective was to evaluate the relationship between risk stratification and therapeutic decision making in patients with non-ST-segment elevation acute coronary syndromes. Methods We analyzed data from 15026 patients with acute coronary syndrome who were enrolled into the GRACE registry between 1999 and 2003. We assessed the evidence-based use of antithrombotic therapy and early invasive strategy according to risk profile defined by baseline troponin elevation, presenting ST-segment depression, and GRACE risk score. Patients with possible contraindications were removed to define the use of therapies specifically among clearly eligible patients. Results Patients with elevated troponin were more likely to receive enoxaparin (60% vs 50.4%, respectively), GP llb/llla inhibitors (32.8% vs 17.6%), and to undergo catheterization (66% vs 54%) and percutaneous coronary intervention (37.4% vs 25.6%; all P <.0001). Patients with ST depression received modestly more enoxaparin and GP llb/llla than those without ST depression, but not more catheterization (P =.8) or percutaneous coronary intervention (P =.09). Highest risk patients were somewhat less likely to receive enoxaparin (P <.0001) and cardiac catheterization (P =.0002) according to GRACE risk deciles. Conclusions In spite of current guidelines recommending the use of selected therapies in high-risk patients, there is no clear correlation of use of effective therapies with overall risk profile even among eligible patients. Thus, there is substantial opportunity to improve use of effective therapies, especially in high-risk populations.
Affiliations:
- Australie, Brésil, Canada, France, Pologne, Royaume-Uni, États-Unis
- Nouvelle-Galles du Sud, Ontario, État de São Paulo, Île-de-France
- Paris, Sydney, São Paulo, Toronto
- Université de Toronto
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Goldberg</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Coronary Care Unit, Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>9 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>The University and The Royal Infirmary of Edinburgh</s1><s2>Edinburgh, Scotland</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>The University and The Royal Infirmary of Edinburgh</wicri:noRegion></affiliation></author><author><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">08-0037451</idno><date when="2007">2007</date><idno type="stanalyst">PASCAL 08-0037451 INIST</idno><idno type="RBID">Pascal:08-0037451</idno><idno type="wicri:Area/PascalFrancis/Corpus">003800</idno><idno type="wicri:Area/PascalFrancis/Curation">002839</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">003524</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">003524</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification</title><author><name sortKey="Oliveira, Gustavo B F" sort="Oliveira, Gustavo B F" uniqKey="Oliveira G" first="Gustavo B. F." last="Oliveira">Gustavo B. F. Oliveira</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Dante Pazzanese Institute of Cardiology</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Avezum, Alvaro" sort="Avezum, Alvaro" uniqKey="Avezum A" first="Alvaro" last="Avezum">Alvaro Avezum</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Dante Pazzanese Institute of Cardiology</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Postgraduate Medical School, Grochowski Hospital</s1><s2>Warsaw</s2><s3>POL</s3><sZ>4 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Dabbous, Omar H" sort="Dabbous, Omar H" uniqKey="Dabbous O" first="Omar H." last="Dabbous">Omar H. Dabbous</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Cardiology, Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Goldberg, Robert J" sort="Goldberg, Robert J" uniqKey="Goldberg R" first="Robert J." last="Goldberg">Robert J. Goldberg</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Coronary Care Unit, Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>9 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>The University and The Royal Infirmary of Edinburgh</s1><s2>Edinburgh, Scotland</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>The University and The Royal Infirmary of Edinburgh</wicri:noRegion></affiliation></author><author><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">The American heart journal</title><title level="j" type="abbreviated">Am. heart j.</title><idno type="ISSN">0002-8703</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The American heart journal</title><title level="j" type="abbreviated">Am. heart j.</title><idno type="ISSN">0002-8703</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cardiology</term><term>Circulatory system</term><term>Evidence-based medicine</term><term>Myocardial infarction</term><term>Phlebology</term><term>Risk</term><term>Risk factor</term><term>ST elevation</term><term>Stratification</term><term>Therapy</term><term>Treatment</term><term>Use</term><term>Variant angina</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Infarctus du myocarde</term><term>Angor instable</term><term>Utilisation</term><term>Traitement</term><term>Thérapie</term><term>Susdécalage ST</term><term>Médecine factuelle</term><term>Facteur risque</term><term>Risque</term><term>Stratification</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Phlébologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Current guidelines advise the use of risk stratification to determine which'patients should receive more aggressive antithrombotic and invasive therapies. Our objective was to evaluate the relationship between risk stratification and therapeutic decision making in patients with non-ST-segment elevation acute coronary syndromes. Methods We analyzed data from 15026 patients with acute coronary syndrome who were enrolled into the GRACE registry between 1999 and 2003. We assessed the evidence-based use of antithrombotic therapy and early invasive strategy according to risk profile defined by baseline troponin elevation, presenting ST-segment depression, and GRACE risk score. Patients with possible contraindications were removed to define the use of therapies specifically among clearly eligible patients. Results Patients with elevated troponin were more likely to receive enoxaparin (60% vs 50.4%, respectively), GP llb/llla inhibitors (32.8% vs 17.6%), and to undergo catheterization (66% vs 54%) and percutaneous coronary intervention (37.4% vs 25.6%; all P <.0001). Patients with ST depression received modestly more enoxaparin and GP llb/llla than those without ST depression, but not more catheterization (P =.8) or percutaneous coronary intervention (P =.09). Highest risk patients were somewhat less likely to receive enoxaparin (P <.0001) and cardiac catheterization (P =.0002) according to GRACE risk deciles. Conclusions In spite of current guidelines recommending the use of selected therapies in high-risk patients, there is no clear correlation of use of effective therapies with overall risk profile even among eligible patients. Thus, there is substantial opportunity to improve use of effective therapies, especially in high-risk populations.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0002-8703</s0></fA01><fA02 i1="01"><s0>AHJOA2</s0></fA02><fA03 i2="1"><s0>Am. heart j.</s0></fA03><fA05><s2>153</s2></fA05><fA06><s2>4</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification</s1></fA08><fA11 i1="01" i2="1"><s1>OLIVEIRA (Gustavo B. F.)</s1></fA11><fA11 i1="02" i2="1"><s1>AVEZUM (Alvaro)</s1></fA11><fA11 i1="03" i2="1"><s1>ANDERSON (Frederick A. JR)</s1></fA11><fA11 i1="04" i2="1"><s1>BUDAJ (Andrzej)</s1></fA11><fA11 i1="05" i2="1"><s1>DABBOUS (Omar H.)</s1></fA11><fA11 i1="06" i2="1"><s1>GOODMAN (Shaun G.)</s1></fA11><fA11 i1="07" i2="1"><s1>GABRIEL STEG (Philippe)</s1></fA11><fA11 i1="08" i2="1"><s1>GOLDBERG (Robert J.)</s1></fA11><fA11 i1="09" i2="1"><s1>BRIEGER (David)</s1></fA11><fA11 i1="10" i2="1"><s1>FOX (Keith A. A.)</s1></fA11><fA11 i1="11" i2="1"><s1>GORE (Joel M.)</s1></fA11><fA11 i1="12" i2="1"><s1>GRANGER (Christopher B.)</s1></fA11><fA14 i1="01"><s1>Dante Pazzanese Institute of Cardiology</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></fA14><fA14 i1="02"><s1>University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></fA14><fA14 i1="03"><s1>Postgraduate Medical School, Grochowski Hospital</s1><s2>Warsaw</s2><s3>POL</s3><sZ>4 aut.</sZ></fA14><fA14 i1="04"><s1>St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></fA14><fA14 i1="05"><s1>Cardiology, Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></fA14><fA14 i1="06"><s1>Coronary Care Unit, Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>9 aut.</sZ></fA14><fA14 i1="07"><s1>The University and The Royal Infirmary of Edinburgh</s1><s2>Edinburgh, Scotland</s2><s3>GBR</s3><sZ>10 aut.</sZ></fA14><fA14 i1="08"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>12 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>GRACE Investigators</s1><s3>BRA</s3></fA17><fA20><s1>493-499</s1></fA20><fA21><s1>2007</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>2057</s2><s5>354000174376750080</s5></fA43><fA44><s0>0000</s0><s1>© 2008 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>34 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>08-0037451</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>The American heart journal</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Background Current guidelines advise the use of risk stratification to determine which'patients should receive more aggressive antithrombotic and invasive therapies. Our objective was to evaluate the relationship between risk stratification and therapeutic decision making in patients with non-ST-segment elevation acute coronary syndromes. Methods We analyzed data from 15026 patients with acute coronary syndrome who were enrolled into the GRACE registry between 1999 and 2003. We assessed the evidence-based use of antithrombotic therapy and early invasive strategy according to risk profile defined by baseline troponin elevation, presenting ST-segment depression, and GRACE risk score. Patients with possible contraindications were removed to define the use of therapies specifically among clearly eligible patients. Results Patients with elevated troponin were more likely to receive enoxaparin (60% vs 50.4%, respectively), GP llb/llla inhibitors (32.8% vs 17.6%), and to undergo catheterization (66% vs 54%) and percutaneous coronary intervention (37.4% vs 25.6%; all P <.0001). Patients with ST depression received modestly more enoxaparin and GP llb/llla than those without ST depression, but not more catheterization (P =.8) or percutaneous coronary intervention (P =.09). Highest risk patients were somewhat less likely to receive enoxaparin (P <.0001) and cardiac catheterization (P =.0002) according to GRACE risk deciles. Conclusions In spite of current guidelines recommending the use of selected therapies in high-risk patients, there is no clear correlation of use of effective therapies with overall risk profile even among eligible patients. Thus, there is substantial opportunity to improve use of effective therapies, especially in high-risk populations.</s0></fC01><fC02 i1="01" i2="X"><s0>002B12A03</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Infarctus du myocarde</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Myocardial infarction</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Infarto miocardio</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Angor instable</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Variant angina</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Angina inestable</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Utilisation</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Use</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Uso</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Traitement</s0><s5>10</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Treatment</s0><s5>10</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Tratamiento</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Thérapie</s0><s5>11</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Therapy</s0><s5>11</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Terapia</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Susdécalage ST</s0><s5>12</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>ST elevation</s0><s5>12</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>ST elevación(ECG)</s0><s5>12</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Médecine factuelle</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Evidence-based medicine</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Medicina basada en pruebas</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Facteur risque</s0><s5>14</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Risk factor</s0><s5>14</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Factor riesgo</s0><s5>14</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Risque</s0><s5>15</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Risk</s0><s5>15</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Riesgo</s0><s5>15</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Stratification</s0><s5>16</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Stratification</s0><s5>16</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Estratificación</s0><s5>16</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Appareil circulatoire</s0><s5>17</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Circulatory system</s0><s5>17</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Aparato circulatorio</s0><s5>17</s5></fC03><fC03 i1="12" i2="X" l="FRE"><s0>Cardiologie</s0><s5>18</s5></fC03><fC03 i1="12" i2="X" l="ENG"><s0>Cardiology</s0><s5>18</s5></fC03><fC03 i1="12" i2="X" l="SPA"><s0>Cardiología</s0><s5>18</s5></fC03><fC03 i1="13" i2="X" l="FRE"><s0>Phlébologie</s0><s5>19</s5></fC03><fC03 i1="13" i2="X" l="ENG"><s0>Phlebology</s0><s5>19</s5></fC03><fC03 i1="13" i2="X" l="SPA"><s0>Flebología</s0><s5>19</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pratique basée sur des preuves</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Evidence-based practice</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Práctica basada en la evidencia</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Cardiopathie coronaire</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Coronary heart disease</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Cardiopatía coronaria</s0><s5>38</s5></fC07><fN21><s1>052</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>Australie</li><li>Brésil</li><li>Canada</li><li>France</li><li>Pologne</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Paris</li><li>Sydney</li><li>São Paulo</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Brésil"><region name="État de São Paulo"><name sortKey="Oliveira, Gustavo B F" sort="Oliveira, Gustavo B F" uniqKey="Oliveira G" first="Gustavo B. F." last="Oliveira">Gustavo B. F. Oliveira</name></region><name sortKey="Avezum, Alvaro" sort="Avezum, Alvaro" uniqKey="Avezum A" first="Alvaro" last="Avezum">Alvaro Avezum</name></country><country name="États-Unis"><noRegion><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name></noRegion><name sortKey="Dabbous, Omar H" sort="Dabbous, Omar H" uniqKey="Dabbous O" first="Omar H." last="Dabbous">Omar H. Dabbous</name><name sortKey="Goldberg, Robert J" sort="Goldberg, Robert J" uniqKey="Goldberg R" first="Robert J." last="Goldberg">Robert J. Goldberg</name><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name></country><country name="Pologne"><noRegion><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name></noRegion></country><country name="Canada"><region name="Ontario"><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name></region></country><country name="Royaume-Uni"><noRegion><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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