AustralieFrV1, PascalFrancis, Curation, bibRecord, 002839

Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification

Identifieur interne : 002839 ( PascalFrancis/Curation ); précédent : 002838; suivant : 002840

Use 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.

RBID : Pascal:08-0037451

Descripteurs français

Pascal (Inist)
- Infarctus du myocarde, Angor instable, Utilisation, Traitement, Thérapie, Susdécalage ST, Médecine factuelle, Facteur risque, Risque, Stratification, Appareil circulatoire, Cardiologie, Phlébologie.

English descriptors

KwdEn :
- Cardiology, Circulatory system, Evidence-based medicine, Myocardial infarction, Phlebology, Risk, Risk factor, ST elevation, Stratification, Therapy, Treatment, Use, Variant angina.

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.

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A11	`02`	`1`		`@1 AVEZUM (Alvaro)`
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C01	`01`		`ENG`	@0 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.
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Le document en format XML

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<author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name>
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<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>
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<author><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name>
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<author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name>
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<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>
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<author><name sortKey="Avezum, Alvaro" sort="Avezum, Alvaro" uniqKey="Avezum A" first="Alvaro" last="Avezum">Alvaro Avezum</name>
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<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>
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<author><name sortKey="Dabbous, Omar H" sort="Dabbous, Omar H" uniqKey="Dabbous O" first="Omar H." last="Dabbous">Omar H. Dabbous</name>
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<author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name>
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<author><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name>
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<author><name sortKey="Goldberg, Robert J" sort="Goldberg, Robert J" uniqKey="Goldberg R" first="Robert J." last="Goldberg">Robert J. Goldberg</name>
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<author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name>
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<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>
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<author><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name>
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<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>
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<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>
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<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>
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<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>
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<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>
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<fA11 i1="01" i2="1"><s1>OLIVEIRA (Gustavo B. F.)</s1>
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<fA11 i1="12" i2="1"><s1>GRANGER (Christopher B.)</s1>
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Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification

Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification

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