Feature | September 10, 2007

Revised Guidelines Respond to New Technology

Cristen Bolan, Editor

Of the 1. 57 million annual hospital admissions in the U.S. for acute coronary syndromes, 1.24 million are due to unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI).
To help standardize the assessment and treatment of these patients, the American College of Cardiology (ACC) and the American Heart Association (AHA) convened a task force to formulate a management guideline.
In August of 2007, these guidelines were revised for the first time in five years. Some of the new strategies diverge markedly from the old, underscoring the impact of clinical research over the last five years, which, in some areas, has caused the task force to change its course.
Compared to the 2002 guidelines, which recommended an early invasive strategy – diagnostic angiography and revascularization – as the way to treat UA/NSTEMI patients, today’s recommended approach is an initial noninvasive set of preliminary tests, such as a stress test, echocardiogram or radionuclide angiogram, for stabilized UA/NSTEMI patients and low risk patients.
Why the change in strategy? The committee explained, “The ability to detect and treat these conditions earlier has greatly improved over the last several years.”
This time around, the committee has modified its view on stent treatment. It is notably cautious and emphasizes the value of intensive, long-term platelet therapy. “Because platelets are thought to play a key role in recurrent heart attack, the anti-platelet therapy clopidogrel is now recommended for at least one year after placement of a drug-eluting stent and shorter term for bare metal stent.” This is not surprising in light of several studies connecting late-stent thrombosis to patients with drug-eluting stent implants.
The lesson to learn from the revised guidelines is firstly, follow the new recommendations, and secondly, until they are revised again, watch the development in medical technology very closely — it’s a tell tale sign of what’s to come in the next set of guidelines.

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