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lüll A simplified approach to the management of non-ST-segment elevation acute coronary syndromes Gluckman TJ; Sachdev M; Schulman SP; Blumenthal RSJAMA 2005[Jan]; 293 (3): 349-57CONTEXT: While current practice guidelines provide an evidence-based approach to management of acute coronary syndromes (ACS), application of the evidence by individual physicians has been suboptimal. OBJECTIVE: To assess and synthesize the evidence regarding optimal management of non-ST-segment elevation ACS (NSTE-ACS). DATA SOURCES: Systematic searches of peer-reviewed publications were performed in MEDLINE and the Cochrane Database from January 1990 through November 2004, with consultation by content experts. Search terms included antiplatelet therapy, antithrombotic therapy, angiotensin-converting enzyme inhibition, angiotensin receptor blockade, beta-blockade, hypertension, hyperlipidemia, cigarette smoking, diet, diabetes mellitus, exercise, myocardial ischemia, and coronary artery disease. STUDY SELECTION AND DATA EXTRACTION: Criteria for selection of studies included controlled study design, English language, and clinical pertinence. Data quality was based on the publishing journal and relevance to clinical management of NSTE-ACS. DATA SYNTHESIS: While outcomes of controlled studies support a comprehensive approach in the management of patients with NSTE-ACS, many physicians perceive existing guidelines as lengthy and complex. After risk stratification to identify those patients most likely to benefit from an early invasive vs early conservative strategy, a comprehensive management plan can be assembled through an "ABCDE" approach. The elements of this include "A" for antiplatelet therapy, anticoagulation, angiotensin-converting enzyme inhibition, and angiotensin receptor blockade; "B" for beta-blockade and blood pressure control; "C" for cholesterol treatment and cigarette smoking cessation; "D" for diabetes management and diet; and "E" for exercise. CONCLUSION: An "ABCDE" approach for the management of NSTE-ACS provides a practical and systematic means to implement evidence-based medicine into clinical practice.|*Practice Guidelines as Topic[MESH]|Adrenergic beta-Antagonists/therapeutic use[MESH]|Angina, Unstable/*therapy[MESH]|Angiotensin-Converting Enzyme Inhibitors/therapeutic use[MESH]|Anticholesteremic Agents/therapeutic use[MESH]|Anticoagulants/therapeutic use[MESH]|Combined Modality Therapy[MESH]|Diet[MESH]|Electrocardiography[MESH]|Exercise[MESH]|Humans[MESH]|Myocardial Infarction/*therapy[MESH]|Platelet Aggregation Inhibitors/therapeutic use[MESH]|Risk Assessment[MESH]|Smoking Cessation[MESH] |