A practical guide to understanding the 2002 ACC/AHA guidelines for the management of patients with non-ST segment elevation acute coronary syndromes.

Numerous advances have been made in recent years in the diagnosis and treatment of patients with acute coronary syndromes (ACS). These advances, based on clinical observations, experience, and randomized clinical trials, have led many cardiologists, emergency medicine physicians, and allied healthcare professionals to change their practices. Some physicians, however, have been slow to embrace the new trends. In fact, research shows that a wide gap exists between how evidence suggests patients with ACS should be treated and how these patients actually are treated across the United States. Since 1980, a joint task force sponsored by the American College of Cardiology (ACC) and the American Heart Association (AHA) has published guidelines for the treatment of various cardiovascular diseases. The guidelines are intended to assist healthcare professionals in making appropriate decisions about the diagnosis and management of specific conditions. The ACC/AHA guidelines for the treatment of patients with unstable angina and non-ST segment elevation ACS (NSTE ACS) were first established in 1994 by the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality. Since the initial publication of the guidelines, angiotensin-converting enzyme (ACE) inhibitors were shown to improve outcomes in patients with coronary artery disease (CAD), platelet glycoprotein (GP) IIb-IIIa inhibitors were shown to reduce the risk of death or nonfatal myocardial infarction (MI) in several large studies, and an early invasive management strategy was shown to reduce long-term mortality. In September 2000, the ACC and AHA jointly published new guidelines for the management of patients with unstable angina or NSTE acute MI (NSTEMI), the two conditions that collectively make up NSTE ACS. The guidelines were further updated in March 2002, based on new evidence. The treatment of patients with unstable angina or NSTEMI has changed dramatically in the past 6 years, and the changes to the guidelines reflect our growing understanding of the disease. Unstable angina and NSTEMI are deadly diseases that have major public health implications. The National Center for Health Statistics reported that in 1996 alone there were 1,433,000 hospitalizations for unstable angina and NSTEMI. Data from the Platelet Glycoprotein IIb-IIIa in Unstable Angina: Receptor SuppresAdditional material related to this article can be found on the Critical Pathways in Cardiology web site. Go to the following address, click on Article Plus button next to the article in Table of