This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Kereiakes, D. J. Articles by Antman, E. M. Search for Related Content PubMed PubMed Citation Articles by Kereiakes, D. J. Articles by Antman, E. M. Related Collections Related Article

Clinical Guidelines and Practice

In Search of the Truth

Dean J. Kereiakes, MD, FACC^1,_*,_* and Elliott M. Antman, MD, FACC

^_* Heart Center of Greater Cincinnati and the Lindner Center at the Christ Hospital, Cincinnati, Ohio
Brigham and Women’s Hospital, Boston, Massachusetts

View larger version (13K): [in a new window]   Figure 1 Randomized controlled trials of invasive versus conservative treatment strategies for unstable angina and non–ST-segment elevation myocardial infarction. The "weight" of evidence favors the invasive strategy. (Adapted from Cannon CP, et al. Circulation 2003;107:2640.)

View larger version (15K): [in a new window]   Figure 2 Link between American College of Cardiology/American Heart Association guideline adherence (hospital composite quality quartiles) and in-hospital mortality. Every 10% increase in guideline adherence was associated with a 10% reduction in in-hospital mortality (adapted from Peterson et al. [31]). *Adjusted for age, gender, body mass index, race, insurance status, family history of coronary disease, hypertension, diabetes, smoking, hypercholesterolemia, prior myocardial infarction/percutaneous coronary intervention/coronary bypass surgery/congestive heart failure/stroke, renal insufficiency, blood pressure, heart rate, ST-segment shift, and positive cardiac biomarkers.

View larger version (11K): [in a new window]   Figure 3 Combination evidence-based therapies reduce mortality to 1 year following myocardial infarction independent of renal function. Patients receiving multiple clinical practice guideline-adherent medications (antiplatelet agents, beta-blockers, lipid-lowering agents, angiotensin-converting enzyme inhibitors) enjoy incremental survival benefit. Adapted from Tay et al. (62). GFR = glomerular filtration rate; CI = confidence interval.