Rehan Qayyum, MD; M. Rizwan Khalid, MD; Jurga Adomaityte, MD; Stylianos P. Papadakos, MD; Frank C. Messineo, MD
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Rehan Qayyum, MD, Johns Hopkins Hospital, Hospitalist Program, 600 North Wolfe Street, Park 307-A, Baltimore, MD 21287; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Qayyum and Adomaityte: Johns Hopkins Hospital, Hospitalist Program, 600 North Wolfe Street, Park 307-A, Baltimore, MD 21287.
Drs. Khalid, Papadakos, and Messineo: Kyrenia Heart Center, New York Hospital Queens, 5645 Main Street, Flushing, New York 11355.
Author Contributions: Conception and design: R. Qayyum, M.R. Khalid, J. Adomaityte.
Analysis and interpretation of the data: R. Qayyum, M.R. Khalid, J. Adomaityte, S.P. Papadakos, F.C. Messineo.
Drafting of the article: R. Qayyum, M.R. Khalid, J. Adomaityte, S.P. Papadakos, F.C. Messineo.
Critical revision of the article for important intellectual content: R. Qayyum, M.R. Khalid, S.P. Papadakos, FC. Messineo.
Final approval of the article: R. Qayyum, M.R. Khalid, J. Adomaityte, S.P. Papadakos, F.C. Messineo.
Statistical expertise: R. Qayyum, M.R. Khalid.
Administrative, technical or logistic support: M.R. Khalid.
Collection and assembly of data: R. Qayyum, M.R. Khalid, J. Adomaityte.
Qayyum R, Khalid MR, Adomaityte J, Papadakos SP, Messineo FC. Systematic Review: Comparing Routine and Selective Invasive Strategies for the Acute Coronary Syndrome. Ann Intern Med. 2008;148:186-196. doi: 10.7326/0003-4819-148-3-200802050-00005
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Published: Ann Intern Med. 2008;148(3):186-196.
Non–ST-segment elevation acute coronary syndrome (ACS) is responsible for almost 1.4 million hospital admissions in the United States (1). Two strategies have been used in managing patients with this syndrome (2). Most patients receive coronary angiography in the routine invasive strategy, whereas angiography is performed only on those patients who are at high risk for subsequent cardiovascular events in the selective invasive strategy (2). In both cases, revascularization is guided by angiographic findings.
It is important to establish whether 1 strategy is superior and whether any differences between the 2 strategies are clinically relevant. To guide clinical management, the American College of Cardiology/American Heart Association guidelines recommend that the routine invasive strategy be used for patients with non–ST-segment elevation ACS who have refractory ischemia; elevated cardiac enzyme levels; new ST-segment depression; or other high-risk features on history, admission characteristics, hospital course, or diagnostic testing (2, 3). Clinical trials offer conflicting evidence to support these recommendations (4–13). Therefore, our aim was to evaluate whether a routine invasive strategy improves cardiovascular outcomes more than a selective invasive strategy in patients with non–ST-segment elevation ACS.
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Cardiology, Emergency Medicine, Acute Coronary Syndromes, Coronary Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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