2000 ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: A practical summary for emergency physicians

There have been numerous significant clinical advances in both the diagnosi s and therapy of acute coronary syndrome during the past several years. Eve n the term "acute coronary syndrome" is a recent creation meant to expand c linical attention in patients with chest pain of coronary origin beyond ide ntification of ST-segment elevation myocardial infarction and prompt initia tion of reperfusion therapy and to include the evaluation and management of those patients with unstable angina (UA) or myocardial injury that does no t cause ST-segment elevation. Many of these advances have been studied and first implemented outside the emergency department, leading some emergency physicians to be slow to embrace them, and leaving others without a viable practical option to use them outside of the cardiac catheterization laborat ory or the coronary care unit. In September 2000, the American College of C ardiology and the American Heart Association issued practice guidelines for the care of patients with UA and non-ST-segment elevation myocardial infar ction. The guidelines specifically address the diagnosis and management of UA and non-ST-segment elevation myocardial infarction in the ED, suggesting evidence-based standards for risk stratification, for the use of biologic markers of myocardial damage and other adjunctive diagnostic tests, and for the appropriate use of antiplatelet and antithrombin therapeutic agents. T his article provides an overview of the ED-pertinent analyses and recommend ations from the 93-page document. A commentary on the implementation of the se recommendations in the ED follows in a separate article.