BRAUNWALD
ET AL., MANAGEMENT OF PATIENTS WITH UNSTABLE ANGINA AND NON-ST-SEGMENT
ELEVATION MYOCARDIAL INFARCTION UPDATE
http://www.acc.org/clinical/guidelines/unstable/update_index.htm
ACC/AHA
2002 Guideline Update for the Management of Patients With Unstable
Angina and Non-ST-Segment Elevation Myocardial Infarction
A
Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines (Committee on the Management of
Patients With Unstable Angina)
This
is a Guideline Update of the 2000 Unstable Angina Guidelines. To
highlight the changes, deleted text is indicated by strikeout, and
revised text is presented in brown. A clean version of the document,
with changes fully incorporated, is available for download and print.
Preamble
It
is important that members of the medical profession play a significant
role in the critical evaluation of the use of diagnostic procedures
and therapies in the management and prevention of disease states.
Rigorous and expert analysis of the available data that document
the relative benefits and risks of those procedures and therapies
can produce helpful guidelines that improve the effectiveness of
care, optimize patient outcomes, and favorably affect the overall
cost of care through a focus of resources on the most effective
strategies.
The
American College of Cardiology (ACC) and the American Heart Association
(AHA) have jointly engaged in the production of such guidelines
in the area of cardiovascular disease since 1980. This effort is
directed by the ACC/AHA Task Force on Practice Guidelines, whose
charge is to develop and revise practice guidelines for important
cardiovascular diseases and procedures. Experts in the subject under
consideration are selected from both organizations to examine subject-specific
data and to write guidelines.
The
process includes additional representatives from other medical practitioner
and specialty groups where appropriate. Writing groups are specifically
charged to perform a formal literature review, to weigh the strength
of evidence for or against a particular treatment or procedure,
and to include estimates of expected health outcomes where data
exist. Patient-specific modifiers, comorbidities, and issues of
patient preference that might influence the choice of particular
tests or therapies are considered, as well as frequency of follow-up
and cost-effectiveness.
The
ACC/AHA Task Force on Practice Guidelines makes every effort to
avoid any actual or potential conflicts of interest that might arise
as a result of an outside relationship or a personal interest of
a member of the writing panel. Specifically, all members of the
writing panel are asked to provide disclosure statements of all
such relationships that might be perceived as real or potential
conflicts of interest. These statements are reviewed by the parent
task force, reported orally to all members of the writing panel
at the first meeting, and updated as changes occur.
These
practice guidelines are intended to assist physicians in clinical
decision making by describing a range of generally acceptable approaches
for the diagnosis, management, or prevention of specific diseases
or conditions. These guidelines represent an attempt to define practices
that meet the needs of most patients in most circumstances. The
ultimate judgment regarding the care of a particular patient must
be made by the physician and patient in light of all of the available
information and the circumstances presented by that patient.
These
guidelines were published in the Journal of the American College
of Cardiology and Circulation in September 2000. The
committee has continuously monitored the literature since the 2000
report to ensure relevancy of its recommendations. The guidelines
have been updated in 2002 via the ACC and AHA web sites to include
the most significant advances that have occurred in the management
of patients with UA/NSTEMI since the 2000 report. A summary article
highlighting the changes to the guidelines will be published in
a subsequent issue of the Journal of the American College of
Cardiology and Circulation. The 2000 guidelines were
officially endorsed by the American College of Emergency Physicians
(ACEP)* and the Society for Cardiac Angiography and Interventions.
Raymond
J. Gibbons, MD, FACC
Chair, ACC/AHA Task Force on Practice Guidelines
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