1. 1 Guidelines Applied to Practice (GAP) American College of Cardiology, Puerto Rico Chapter

2. 2 INTRODUCTION San Juan : Hotel Intercontinental, Dec. 12, 2006 - Jorge Ortega Gil, MD Mayagüez : Casa del Médico, Dec. 13, 2006 – Marcos Velázquez, MD Ponce : Casa del Médico, Dec. 14, 2006 – José Gómez Rivera, MD Guidelines Applied to Practice (GAP) Acute Coronary Syndromes

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5. 5 Ischemic Heart Disease in the United States The Magnitude of the Health Problem  Despite the well documented recent decline in cardiovascular mortality, IHD remains the leading cause of death  The initial clinical presentation is about the same for both chronic and acute coronary syndromes (50% each)  About 1.5 million myocardial infarctions occur each year, one third to one half are fatal 200,000 have silent infarctions 200,000 have silent infarctions  16 million people have symptomatic CAD  Approximately 2.5 % of totally asymptomatic middle-aged men have silent myocardial ischemia  One million each PCI and CABG are performed each year  Annual cost in 2004 was about $368 billion

6. 6 The ACC/AHA Guideline Classifications Class I: Evidence and / or agreement that treatment is effective Class IIa: Weight of evidence favors use Class IIb: Usefulness less well established Class III: Evidence and/ or agreement that treatment is not effective Level of evidence: A (high rank) – Based on large randomized trials B (Intermediate rank) Based on smaller trials or careful analyses C (low rank) – Based on expert consensus