Key Articles and Guidelines in the Management of Acute Coronary Syndromes and in Percutaneous Coronary Intervention: 2007 Update

Paul P. Dobesh, Pharm.D., FCCP; Sara D. Brouse, Pharm.D.; William E. Dager, Pharm.D., FCSHP; Sarah A. Spinler, Pharm.D., FCCP; Zachary Stacy, Pharm.D.; Barbara S. Wiggins, Pharm.D.

Disclosures

Pharmacotherapy. 2007;27(12):1722-1758. 

In This Article

Abstract and Introduction

Abstract

Clinical evidence in the management of acute coronary syndromes (ACS) and in percutaneous coronary intervention (PCI) continues to evolve at a rapid pace. For clinicians to provide optimal care for these patients, it is important to keep up with new information as it becomes available. With the existence of numerous pharmacologic agents, abundance of major clinical trials, and several nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on the care of patients with ACS or those undergoing PCI can be difficult for clinicians. Therefore, we provide an update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. A number of guidelines and practice-changing literature have been published since the initial 2004 document. We hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease.

Introduction

Over the past several years, our knowledge of the treatment of cardiovascular disease has advanced significantly. Despite these advance-ments, cardiovascular disease continues to be a global issue as a leading cause of morbidity and mortality. In the United States, the financial burden of managing cardiovascular disease is anticipated to be more than $400 billion in 2007.[1] Patients with acute coronary syndromes (ACS) usually have ruptured coronary athero-sclerotic plaque and significant thrombosis at presentation. Current statistics suggest that there are more than 1.5 million emergency department visits related to ACS in the United States every year. Of these visits, approximately 43% are for unstable angina, 36% for non–ST-segment elevation myocardial infarction (non-STEMI), and 21% for ST-segment elevation myocardial infarction (STEMI).[1]

The Cardiology Practice and Research Network of the American College of Clinical Pharmacy took the initiative to compile five collections of key articles and guidelines in major focus areas of cardiology. In 2004–2006, these collections of annotative bibliographies were published on the topics of ACS, arrhythmias, hypertension, systolic heart failure, and dyslipidemias.[2–6] These documents serve as excellent reviews and resources for pharmacists, physicians, nurses, residents, and students. Because of the rapidly changing evidence in cardiology, these reviews need to be updated. The ACS collection[2] was the first one to be published, in January 2004, and is now the first to be updated. Because of the growing role of percutaneous coronary intervention (PCI) in the treatment of patients with ACS and in non-ACS coronary disease, the literature on the pharmacologic agents used during PCI has been included in this update. We collected guidelines and significant articles published since the original document and provide a summary of the results of the clinical trials and their clinical insights on the implications on clinical practice and research. Appendix 1 is an alphabetically arranged list of the acronyms for these ACS and PCI clinical trials.

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