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Guidelines for the diagnosis and treatment of non-ST- segment elevation acute coronary syndromes by Jean-Pierre Bassand, Christian W. Hamm, Diego Ardissino,

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Presentation on theme: "Guidelines for the diagnosis and treatment of non-ST- segment elevation acute coronary syndromes by Jean-Pierre Bassand, Christian W. Hamm, Diego Ardissino,"— Presentation transcript:

1 Guidelines for the diagnosis and treatment of non-ST- segment elevation acute coronary syndromes by Jean-Pierre Bassand, Christian W. Hamm, Diego Ardissino, Eric Boersma, Andrzej Budaj, Francisco Fernández-Avilés, Keith A.A. Fox, David Hasdai, E. Magnus Ohman, Lars Wallentin, William Wijns, Alec Vahanian, John Camm, Raffaele De Caterina, Veronica Dean, Kenneth Dickstein, Gerasimos Filippatos, Steen Dalby Kristensen, Petr Widimsky, Keith McGregor, Udo Sechtem, Michal Tendera, Irene Hellemans, José Luis Zamorano Gomez, Sigmund Silber, Christian Funck-Brentano, Steen Dalby Kristensen, Felicita Andreotti, Werner Benzer, Michel Bertrand, Amadeo Betriu, Raffaele De Caterina, Johan DeSutter, Volkmar Falk, Antonio Fernandez Ortiz, Anselm Gitt, Yonathan Hasin, Kurt Huber, Ran Kornowski, Jose Lopez- Sendon, Joao Morais, Jan Erik Nordrehaug, Sigmund Silber, Philippe Gabriel Steg, Kristian Thygesen, Marco Tubaro, Alexander G.G. Turpie, Freek Verheugt, and Stephan Windecker EHJ Volume (): June 14, 2007 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

2 The spectrum of acute coronary syndromes. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

3 Example of release of cardiac markers in a patient with non-ST-elevation acute coronary syndrome (shaded area indicates normal range). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

4 Death, myocardial infarction, and major bleeds at the completion of study medication in randomized trials of unfractionated heparin/low molecular weight heparin (filled bars) vs. control (open bars). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

5 Death, myocardial infarction, and major bleeds at 30 days in randomized trials of enoxaparin (filled bars) vs. unfractionated heparin (open bars). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

6 Death, myocardial infarction, and major bleeds at 30 days in randomized trials of direct thrombin inhibitors (filled bars) vs. unfractionated heparin/low molecular weight heparin (open bars). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

7 Death, myocardial infarction, and major bleeds at the end of study medication in four randomized trials of aspirin (filled bars) vs. control (open bars). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

8 Death, myocardial infarction, and major bleeds at 30 days in randomized trials of glycoprotein IIb/IIIa inhibitors (filled bars) vs. control (open bars) in a conservative strategy. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

9 Death or myocardial infarction in six contemporary randomized trials comparing early invasive (filled bars) vs. conservative strategy (open bars). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

10 The ability to demonstrate relative mortality benefit with the revascularization strategy depends on the gradient in rates of revascularization between both randomization arms. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

11 Kernel curves of in-hospital mortality (black) or bleeding (grey) according to the level of creatinine clearance in patients treated with unfractionated heparin (plain curves) and low molecular weight heparin (dashed curves). Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

12 Clinical outcomes for patients stratified by age (invasive vs. conservative strategies) from the TACTICS–TIMI-18 trial.420 Reproduced with permission. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

13 Treatment effect on 30-day mortality among diabetic patients with non-ST-elevation acute coronary syndrome from six randomized clinical trials.233 Reproduced with permission. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

14 Hospital outcomes according to degree of renal function impairment for the subgroup of patients with non-ST-elevation myocardial infarction/unstable angina from the GRACE registry.460 Heart 2003;89:1003–1008, reproduced with permission from the BMJ Publishing Group. *P < 0.05 across all categories of renal function within the non-ST-elevation myocardial infarction/unstable angina subgroup. **P < 0.0001 across all categories of renal function within the non-ST-elevation myocardial infarction/unstable angina subgroup. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

15 Decision-making algorithm for the management of patients with non-ST-elevation acute coronary syndrome. Jean-Pierre Bassand et al. Eur Heart J 2007;eurheartj.ehm161 © The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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