In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome

1. Lloyd-Jones D, Adams R, Carnethon M, et al.American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2009 update. a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published correction appears in Circulation. 2009;119(3):e182] Circulation 2009January27;119(3):480-486 Epub 2008 Dec 15 [PubMed] [Google Scholar]

2. Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988;77(6):1213-1220 [PubMed] [Google Scholar]

3. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med. 1992;326(5):310-318 [PubMed] [Google Scholar]

4. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 2001;104(3):365-372 [PubMed] [Google Scholar]

5. Corti R, Fuster V, Badimon JJ, Hutter R, Fayad ZA. New understanding of atherosclerosis (clinically and experimentally) with evolving MRI technology in vivo. Ann N Y Acad Sci. 2001;947:181-195 [PubMed] [Google Scholar]

6. Kinlay S, Libby P, Ganz P. Endothelial function and coronary artery disease. Curr Opin Lipidol. 2001;12(4):383-389 [PubMed] [Google Scholar]

7. Webster MWI, Chesebro JH, Smith HC, et al. Myocardial infarction and coronary artery occlusion: a prospective 5-year angiographic study. J Am Coll Cardiol. 1990;15:218A [Google Scholar]

8. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20(5):1262-1275 [PubMed] [Google Scholar]

9. Moreno PR, Falk E, Palacios IF, Newell JB, Fuster V, Fallon JT. Macrophage infiltration in acute coronary syndromes: implications for plaque rupture. Circulation 1994;90(2):775-778 [PubMed] [Google Scholar]

10. van der Wal AC, Becker AE, van der Loos CM, Das PK. Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 1994;89(1):36-44 [PubMed] [Google Scholar]

11. Davies MJ, Richardson PD, Woolf N, Katz DR, Mann J. Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content. Br Heart J. 1993;69(5):377-381 [PMC free article] [PubMed] [Google Scholar]

12. Sukhova GK, Schönbeck U, Rabkin E, et al. Evidence for increased collagenolysis by interstitial collagenases-1 and -3 in vulnerable human atheromatous plaques. Circulation 1999;99(19):2503-2509 [PubMed] [Google Scholar]

13. Herman MP, Sukhova GK, Libby P, et al. Expression of neutrophil collagenase (matrix metalloproteinase-8) in human atheroma: a novel collagenolytic pathway suggested by transcriptional profiling. Circulation 2001;104(16):1899-1904 [PubMed] [Google Scholar]

14. Schoenhagen P, Ziada KM, Kapadia SR, Crowe TD, Nissen SE, Tuzcu EM. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000;101(6):598-603 [PubMed] [Google Scholar]

15. von Birgelen C, Klinkhart W, Mintz GS, et al. Plaque distribution and vascular remodeling of ruptured and nonruptured coronary plaques in the same vessel: an intravascular ultrasound study in vivo. J Am Coll Cardiol. 2001;37(1):1864-1870 [PubMed] [Google Scholar]

16. Rauch U, Osende JI, Fuster V, Badimon JJ, Fayad Z, Chesebro JH. Thrombus formation on atherosclerotic plaques: pathogenesis and clinical consequences. Ann Intern Med. 2001;134:224-238 [PubMed] [Google Scholar]

17. Davies MJ. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 1990;82(3) (suppl):II38-II46 [PubMed] [Google Scholar]

18. Lendon CL, Davies MJ, Born GV, Richardson PD. Atherosclerotic plaque caps are locally weakened when macrophages density is increased. Atherosclerosis 1991;87(1):87-90 [PubMed] [Google Scholar]

19. Tanaka A, Shimada K, Sano T, et al. Multiple plaque rupture and C-reactive protein in acute myocardial infarction. J Am Coll Cardiol. 2005May17;45(10):1594-1599 Epub 2005 Apr 25 [PubMed] [Google Scholar]

20. Sano T, Tanaka A, Namba M, et al. C-reactive protein and lesion morphology in patients with acute myocardial infarction. Circulation 2003July22;108(3):282-285 Epub 2003 Jun 30 [PubMed] [Google Scholar]

21. Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation 2003;108(14):1664-1672 [PubMed] [Google Scholar]

22. Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part II. Circulation 2003;108(15):1772-1778 [PubMed] [Google Scholar]

23. Lüscher TF, Tanner FC, Noll G. Lipids and endothelial function: effects of lipid-lowering and other therapeutic interventions. Curr Opin Lipidol. 1996;7(4):234-240 [PubMed] [Google Scholar]

24. Chen L, Chester MR, Crook R, Kaski JC. Differential progression of complex culprit stenoses in patients with stable and unstable angina pectoris. J Am Coll Cardiol. 1996;28(3):597-603 [PubMed] [Google Scholar]

25. Moreno PR, Bernardi VH, López-Cuéllar J, et al. Macrophages, smooth muscle cells, and tissue factor in unstable angina: implications for cell-mediated thrombogenicity in acute coronary syndromes. Circulation 1996;94(12):3090-3097 [PubMed] [Google Scholar]

26. Fosang AJ, Smith PJ. Human genetics: to clot or not. Nature 2001;413:475-476 [PubMed] [Google Scholar]

27. Weiss EJ, Bray PF, Tayback M, et al. A polymorphism of a platelet glycoprotein receptor as an inherited risk factor for coronary thrombosis. N Engl J Med. 1996;334(17):1090-1094 [PubMed] [Google Scholar]

28. Rioufol G, Finet G, Ginon I, et al. Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 2002;106(7):804-808 [PubMed] [Google Scholar]

29. Conti CR, Brawley RK, Griffith LS, et al. Unstable angina pectoris: morbidity and mortality in 57 consecutive patients evaluated angiographically. Am J Cardiol. 1973;32(6):745-750 [PubMed] [Google Scholar]

30. Mizuno K, Satumo K, Miyamoto A, et al. Angioscopic evaluation of coronary artery thrombi in acute coronary syndromes. N Engl J Med. 1992;326(5):287-291 [PubMed] [Google Scholar]

31. The TIMI IIIA Investigators Early effects of tissue-type plasminogen activator added to conventional therapy on the culprit lesion in patients presenting with ischemic cardiac pain at rest: results of the Thrombolysis in Myocardial Ischemia (TIMI IIIA) Trial. Circulation 1993;87(1):38-52 [PubMed] [Google Scholar]

32. Sullivan E, Kearney M, Isner JM, Topol EJ, Losorda DW. Pathology of unstable angina: analysis of biopsies obtained by directional coronary atherectomy. J Thromb Thrombolysis 1994;1(1):63-71 [PubMed] [Google Scholar]

33. Sherman CT, Litvack F, Grundfest W, et al. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med. 1986;315(15):913-919 [PubMed] [Google Scholar]

34. DeWood MA, Spores J, Notske R, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303(16):897-902 [PubMed] [Google Scholar]

35. Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med. 1983;309(7):396-403 [PubMed] [Google Scholar]

36. Théroux P, Ouimet H, McCans J, et al. Aspirin, heparin or both to treat unstable angina. N Engl J Med. 1988;319(17):1105-1111 [PubMed] [Google Scholar]

37. Cohen M, Demers C, Gurfinkel EP, et al.Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med. 1997;337(7):447-452 [PubMed] [Google Scholar]

38. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation [published corrections appear in N Engl J Med. 2001;345(23):1716 and 2001;345(20):1506] N Engl J Med. 2001;345(7):494-502 [PubMed] [Google Scholar]

39. Platelet Receptor Inhibition for Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Trial Investigators Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction [published correction appears in N Engl J Med. 1998;339(6):415] N Engl J Med. 1998;338(21):1488-1497 [PubMed] [Google Scholar]

40. Cannon CP, Weintraub WS, Demopoulos LA, et al.TACTICS-Thrombolysis in Myocardial Infarction 18 Investigators Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344(25):1879-1887 [PubMed] [Google Scholar]

41. Cannon CP, Braunwald E. Time to reperfusion: the critical modulator in thrombolysis and primary angioplasty. J Thromb Thrombolysis 1996;3(2):117-125 [PubMed] [Google Scholar]

42. Anderson JL, Adams CD, Antman EM, et al.Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol. 2007;50(7):e1-e157 [PubMed] [Google Scholar]

43. McDermott MM, Mandapat AL, Moates A, et al. Knowledge and attitudes regarding cardiovascular disease risk and prevention in patients with coronary or peripheral arterial disease. Arch Intern Med. 2003;163(18):2157-2162 [PubMed] [Google Scholar]

44. Pope JH, Ruthazer R, Beshansky JR, Griffith JL, Selker HR. Clinical features of emergency department patients presenting with symptoms suggestive of acute cardiac ischemia: a multicenter study. J Thromb Thrombolysis 1998;6(1):63-74 [PubMed] [Google Scholar]

45. Braunwald E, Mark DB, Jones RH, et al. Unstable angina: diagnosis and management Rockville, MD: Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, US Public Health Service, US Dept of Health and Human Services, 1994. AHCPR Publication No. 94-0602 (124) [Google Scholar]

46. Abidov A, Rozanski A, Hachamovitch R, et al. Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005;353(18):1889-1898 [PubMed] [Google Scholar]

47. Pryor DB, Shaw L, McCants CB, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993;118(2):81-90 [PubMed] [Google Scholar]

48. Morise AP, Haddad WJ, Beckner D. Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med. 1997;102(4):350-356 [PubMed] [Google Scholar]

49. Jayes RL, Jr, Beshansky JR, D'Agostino RB, Selker HP. Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study. J Clin Epidemiol. 1992;45(6):621-626 [PubMed] [Google Scholar]

50. Cannon CP, McCabe CH, Stone PH, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J Am Coll Cardiol. 1997;30(1):133-140 [PubMed] [Google Scholar]

51. Savonitto S, Ardissino D, Granger CB, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 1999;281(8):707-713 [PubMed] [Google Scholar]

52. Hyde TA, French JK, Wong CK, Straznicky IT, Whitlock RM, White HD. Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression. Am J Cardiol. 1999;84(4):379-385 [PubMed] [Google Scholar]

53. Yusuf S, Pearson M, Sterry H, et al. The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction. Eur Heart J. 1984;5(9):690-696 [PubMed] [Google Scholar]

54. Brush JE, Jr, Brand DA, Acampora D, Chalmer B, Wackers FJ. Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. N Engl J Med. 1985;312(18):1137-1141 [PubMed] [Google Scholar]

55. Braunwald E, Jones RH, Mark DB, et al. Diagnosing and managing unstable angina. Circulation 1994;90(1):613-622 [PubMed] [Google Scholar]

56. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996;28(5):1328-1428 [PubMed] [Google Scholar]

57. McCord J, Nowak RM, McCullough PA, et al. Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I. Circulation 2001;104(13):1483-1488 [PubMed] [Google Scholar]

58. Shapiro BP, Babuin L, Jaffe AS. Cardiac biomarkers. In: Murphy JG, Lloyd MA, eds. Mayo Clinic Cardiology: Concise Textbook 3rd ed.Rochester, MN: Mayo Clinic Scientific Press; and New York: Informa Healthcare USA; 2007:773-780 [Google Scholar]

59. Jaber WA, Prior DL, Marso SP, Houghtaling PL, Menon V, Harrington RA. CHF on presentation is associated with markedly worse outcomes among patients with acute coronary syndromes: PURSUIT trial findings. Circulation 1999;100(suppl I):I433 [Google Scholar]

60. Steinhubl SR, Berger PB, Mann JT, III, et al.CREDO Investigators Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial [published correction appears in JAMA. 2003;289(8):987] JAMA 2002;288(19):2411-2420 [PubMed] [Google Scholar]

61. Batter A. The Euro Heart Survey of Acute Coronary Syndromes (EHSACS) Presented at: European Society of Cardiology Scientific Sessions Stockholm, Sweden; September1-5, 2001 [Google Scholar]

62. Hamm CW, Heeschen C, Goldmann B, et al.c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) Study Investigators Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels [published correction appears in N Engl J Med. 1999;341(7):548] N Engl J Med. 1999;340(21):1623-1629 [PubMed] [Google Scholar]

63. Heeschen C, Hamm CW, Goldmann B, PRISM Study Investigators Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. Lancet 1999;354(9192):1757-1762 [PubMed] [Google Scholar]

64. FRagmin and Fast Revascularisation during InStability in Coronary artery disease (FRISC II) Investigators Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet 1999;354(9180):708-715 [PubMed] [Google Scholar]

65. Boersma E, Pieper KS, Steyerberg EW, et al.PURSUIT Investigators Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9461 patients. Circulation 2000;101(22):2557-2567 [PubMed] [Google Scholar]

66. Théroux P, Alexander J, Jr, Pharand C, et al. Glycoprotein IIb/IIIa receptor blockade improves outcomes in diabetic patients presenting with unstable angina/non-ST-elevation myocardial infarction: results from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study. Circulation 2000;102(20):2466-2472 [PubMed] [Google Scholar]

67. Roffi M, Chew DP, Mukherjee D, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes. Circulation 2001;104(23):2767-2771 [PubMed] [Google Scholar]

68. Cotter G, Cannon CP, McCabe CH, Charlesworth A, Caspi A, Braunwald E. Prior peripheral vascular disease and cerebrovascular disease are independent predictors of increased 1 year mortality in patients with acute coronary syndromes: results from OPUS-TIMI 16 [abstract]. J Am Coll Cardiol. 2000;35(suppl A):410A [Google Scholar]

69. Santopinto J, Gurfinkel EP, Torres V, et al. Prior aspirin users with acute non-ST-elevation coronary syndromes are at increased risk of cardiac events and benefit from enoxaparin. Am Heart J. 2001;141(4):566-572 [PubMed] [Google Scholar]

70. Mauri F, Franzosi MG, Maggioni AP, Santoro E, Santoro L. Clinical value of 12-lead electrocardiography to predict the long-term prognosis of GISSI-1 patients. J Am Coll Cardiol. 2002;39(10):1594-1600 [PubMed] [Google Scholar]

71. Morrow DA, Cannon CP, Rifai N, et al.TACTICS-TIMI 18 Investigators Ability of minor elevations of troponin I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA 2001;286(19):2405-2412 [PubMed] [Google Scholar]

72. Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335(18):1342-1349 [PubMed] [Google Scholar]

73. Morrow DA, Rifai N, Antman EM, et al. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. J Am Coll Cardiol. 1998;31(7):1460-1465 [PubMed] [Google Scholar]

74. Cannon CP, McCabe CH, Wilcox RG, Bentley JH, Braunwald E, OPUS-TIMI 16 Investigators Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris. Am J Cardiol. 2001;87(5):636-639, A10 [PubMed] [Google Scholar]

75. Sabatine MS, Morrow DA, Cannon CP, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 substudy. J Am Coll Cardiol. 2002;40(10):1761-1768 [PubMed] [Google Scholar]

76. Baldus S, Heeschen C, Meinertz T, et al.CAPTURE Investigators Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation 2003September23;108(12):1440-1445 Epub 2003 Sep 2 [PubMed] [Google Scholar]

77. James SK, Lindahl B, Siegbahn A, et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation 2003;108(3):275-281 Epub 2003 Jul 7 [PubMed] [Google Scholar]

78. de Lemos JA, Morrow DA, Bentley JH, et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med. 2001;345(14):1014-1021 [PubMed] [Google Scholar]

79. Mega JL, Morrow DA, De Lemos JA, et al. B-type natriuretic peptide at presentation and prognosis in patients with ST-segment elevation myocardial infarction: an ENTIRE-TIMI-23 substudy. J Am Coll Cardiol. 2004;44(2):335-339 [PubMed] [Google Scholar]

80. Arakawa N, Nakamura M, Aoki H, Hiramori K. Relationship between plasma level of brain natriuretic peptide and myocardial infarct size. Cardiology 1994;85(5):334-340 [PubMed] [Google Scholar]

81. Sabatine MS, Morrow DA, de Lemos JA, et al. Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide. Circulation 2002;105(15):1760-1763 [PubMed] [Google Scholar]

82. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284(7):835-842 [PubMed] [Google Scholar]

83. Morrow DA, Antman EM, Snapinn SM, McCabe CH, Theroux P, Braunwald E. An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes: application of the TIMI Risk Score for UA/NSTEMI in PRISM-PLUS. Eur Heart J. 2002;23(3):223-229 [PubMed] [Google Scholar]

84. James SK, Lindbäck J, Tilly J, et al. Troponin-T and N-terminal pro-B-type natriuretic peptide predict mortality benefit from coronary revascularization in acute coronary syndromes: a GUSTO-IV substudy. J Am Coll Cardiol. 2006;48(6):1146-1154 Epub 2006 Aug 28 [PubMed] [Google Scholar]

85. Eagle KA, Lim MJ, Dabbous OH, et al.GRACE Investigators A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291(22):2727-2733 [PubMed] [Google Scholar]

86. Granger CB, Goldberg RJ, Dabbous O, et al.Global Registry of Acute Coronary Events Investigators Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345-2353 [PubMed] [Google Scholar]

87. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102(17):2031-2037 [PubMed] [Google Scholar]

88. Wiviott SD, Morrow DA, Frederick PD, et al. Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4: a simple index that predicts mortality in ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2004;44(4):783-789 [PubMed] [Google Scholar]

89. CIBIS-II Investigators and Committees The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999;353(9146):9-13 [PubMed] [Google Scholar]

90. de Winter RJ, Windhausen F, Cornel JH, et al.Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353(11):1095-1104 [PubMed] [Google Scholar]

91. Hirsch A, Windhausen F, Tijssen JG, Verheugt FW, Cornel JH, de Winter RJ, Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) investigators Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study. Lancet 2007;369(9564):827-835 [PubMed] [Google Scholar]

92. Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006October3;48(7):1319-1325 Epub 2006 Sep 12 [PubMed] [Google Scholar]

93. O'Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 2008;300(1):71-80 [PubMed] [Google Scholar]

94. Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-2175 [PubMed] [Google Scholar]

95. Cheitlin MD, Hutter AM, Jr, Brindis RG, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease [published correction appears in J Am Coll Cardiol. 1999;34(6):1850] J Am Coll Cardiol. 1999;33(1):273-282 [PubMed] [Google Scholar]

96. Meine TJ, Roe MT, Chen AY, et al.CRUSADE Investigators Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J. 2005;149(6):1043-1049 [PubMed] [Google Scholar]

97. Gislason GH, Jacobsen S, Rasmussen JN, et al. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction. Circulation 2006June27;113:2906-2913 Epub 2006 Jun 19 [PubMed] [Google Scholar]

98. Gibson CM, Pride YB, Aylward PE, et al. Association of non-steroidal anti-inflammatory drugs with outcomes in patients with ST-segment elevation myocardial infarction treated with fibrinolytic therapy: an ExTRACT-TIMI 25 analysis. J Thromb Thrombolysis 2009January;27(1):11-17 Epub 2008 Aug 10 [PubMed] [Google Scholar]

99. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366(9497):1622-1632 [PubMed] [Google Scholar]

100. Gottlieb SO, Weisfeldt ML, Ouyang P, et al. Effect of the addition of propranolol to therapy with nifedepine for unstable angina: a randomized, double-blind, placebo-controlled trial. Circulation 1986;73(2):331-337 [PubMed] [Google Scholar]

101. The Holland Interuniversity Nifedipine/Metoprolol Trial (HINT) Research Group Early treatment of unstable angina in the coronary care unit: a randomised, double blind, placebo controlled comparison of recurrent ischaemia in patients treated with nifedipine or metoprolol or both. Br Heart J. 1986;56(5):400-413 [PMC free article] [PubMed] [Google Scholar]

102. Théroux P, Taeymans Y, Morissette D, Bosch X, Pelletier GB, Waters DD. A randomized study comparing propranolol and diltiazem in the treatment of unstable angina. J Am Coll Cardiol. 1985;5(3):717-722 [PubMed] [Google Scholar]

103. Rizik D, Timmis GC, Grines CL, Bakalyar D, Schreiber T. Immediate use of beta blockers, but not calcium blockers, improves prognosis in unstable angina [abstract]. Circulation 1991;84(suppl. II):II-345 [Google Scholar]

104. The Multicenter Diltiazem Postinfarction Trial Research Group The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med. 1988;319(7):385-392 [PubMed] [Google Scholar]

105. The Danish Study Group on Verapamil in Myocardial Infarction Verapamil in acute myocardial infarction. Eur Heart J. 1984;5(7):516-528 [PubMed] [Google Scholar]

106. Pepine CJ, Faich G, Makuch R. Verapamil use in patients with cardiovascular disease: an overview of randomized trials. Clin Cardiol. 1998;21(9):633-641 [PMC free article] [PubMed] [Google Scholar]

107. Gibson RS, Boden WE, Theroux P, et al. Diltiazem and reinfarction in patients with non-Q wave myocardial infarction: results of a double-blind, randomized, multicenter trial. N Engl J Med. 1986;315(7):423-429 [PubMed] [Google Scholar]

108. Wilcox RG, Hampton JR, Banks DC, et al. Trial of early nifedepine in acute myocardial infarction: the Trent study. Br Med J (Clin Res Ed) 1986;293(6556):1204-1208 [PMC free article] [PubMed] [Google Scholar]

109. Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004;292(18):2217-2225 [PubMed] [Google Scholar]

110. Jamerson K, Weber MA, Bakris GL, et al.ACCOMPLISH Trial Investigators Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359(23):2417-2428 [PubMed] [Google Scholar]

111. ISIS-4 Collaborative Group ISIS-4: randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1995;345(8951):669-685 [PubMed] [Google Scholar]

112. Chinese Cardiac Study Collaborative Group Oral captopril versus placebo among 13,634 patients with suspected myocardial infarction: interim report from the Chinese Cardiac Study (CCS-1). Lancet 1995;345(8951):686-687 [PubMed] [Google Scholar]

113. Pfeffer MA, McMurray JJ, Velazquez EJ, et al.Valsartan in Acute Myocardial Infarction Trial Investigators Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both [published correction appears in N Engl J Med. 2004;350(2):203] N Engl J Med. 2003November13;349(20):1893-1906 Epub 2003 Nov 10 [PubMed] [Google Scholar]

114. Gustafsson I, Torp-Pedersen C, Køber L, Gustafsson F, Hildebrandt P, Trace Study Group Effect of the angiotensin-converting enzyme inhibitor trandolapril on mortality and morbidity in diabetic patients with left ventricular dysfunction after acute myocardial infarction. J Am Coll Cardiol. 1999;34(1):83-89 [PubMed] [Google Scholar]

115. Heart Outcomes Prevention Evaluation Study Investigators Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients [published corrections appear in N Engl J Med. 2000;342(18):1376 and 2000;342(10):748] N Engl J Med. 2000;342:145-153 [PubMed] [Google Scholar]

116. Pitt B, Remme W, Zannad F, et al.Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction [published correction appears in N Engl J Med. 2003 Apr 3;348(22):2271] N Engl J Med. 2003;348(14):1309-1321 Epub 2003 Mar 31 [PubMed] [Google Scholar]

117. Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Skene A, McCabe CH, Braunwald E, MERLIN-TIMI 36 Investigators Evaluation of a novel anti-ischemic agent in acute coronary syndromes: design and rationale for the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-elevation acute coronary syndromes (MERLIN)-TIMI 36 trial. Am Heart J. 2006;151(6):1186.e1-1186.e9 [PubMed] [Google Scholar]

118. Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, et al.MERLIN-TIMI 36 Investigators Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA 2007;297(16):1775-1783 [PubMed] [Google Scholar]

119. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina; results of a Canadian multicenter trial. N Engl J Med. 1985;313(22):1369-1375 [PubMed] [Google Scholar]

120. RISC Group Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990;336(8719):827-830 [PubMed] [Google Scholar]

121. CURE Study Investigators The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur Heart J. 2000;21(24):2033-2041 [PubMed] [Google Scholar]

122. Mehta SR, Yusuf S, Peters RJ, et al.Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001;358(9281):527-533 [PubMed] [Google Scholar]

123. Sabatine MS, Cannon CP, Gibson CM, et al.Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)-Thrombolysis in Myocardial Infarction (TIMI) 28 Investigators Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 2005September14;294(10):1224-1232 Epub 2005 Sep 4 [PubMed] [Google Scholar]

124. Smith SC, Jr, Feldman TE, Hirshfeld JW, Jr, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention-Summary Article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervent ion). J Am Coll Cardiol. 2006;47(1):216-235http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=16386696&dopt=Abstract [PubMed] [Google Scholar]

125. King SB, III, Smith SC, Jr, Hirshfeld JW, Jr, et al. 2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2008 Jan 15;117(6):e161] Circulation 2008;117(2):261-295 Epub 2007 Dec 13 [PubMed] [Google Scholar]

126. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery) [published correction appears in Circulation. 2005;111(15):2014] Circulation 2004;110(9):1168-1176 [PubMed] [Google Scholar]

127. Wiviott SD, Trenk D, Frelinger AL, et al.PRINCIPLE-TIMI 44 Investigators Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 trial. Circulation 2007December18;116(25):2923-2932 Epub 2007 Dec 3 [PubMed] [Google Scholar]

128. Wiviott SD, Braunwald E, McCabe CH, et al.TRITON-TIMI 38 Investigators Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007November15;357(20):2001-2015 Epub 2007 Nov 4 [PubMed] [Google Scholar]

129. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. [epub before print.]. N Engl J Med. 2009;361 [PubMed] [Google Scholar]

130. Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials [published correction appears in Lancet. 2002;359(9323):2120] Lancet 2002;359(9302):189-198 [PubMed] [Google Scholar]

131. Klootwijk P, Meij S, Melkert R, Lenderink T, Simoons ML. Reduction of recurrent ischemia with abciximab during continuous ECG-ischemia monitoring in patients with unstable angina refractory to standard treatment (CAPTURE). Circulation 1998;98(14):1358-1364 [PubMed] [Google Scholar]

132. Alexander JH, Harrington RA, Tuttle RH, et al.PURSUIT Investigators Prior aspirin use predicts worse outcomes in patients with non-ST-elevation acute coronary syndromes. Am J Cardiol. 1999;83(8):1147-1151 [PubMed] [Google Scholar]

133. Kastrati A, Mehilli J, Neumann FJ, et al. Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 2 (ISAR-REACT 2) Trial Investigators. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 2006April;295(13):1531-1538 Epub 2006 Mar 13 [PubMed] [Google Scholar]

134. Giugliano RP, White JA, Bode C, et al.EARLY ACS Investigators Early versus delayed, provisional eptifibatide in acute coronary syndromes. N Engl J Med. 2009May21;360:2176-2190 Epub 2009 Mar 30 [PubMed] [Google Scholar]

135. Théroux P, Waters D, Qiu S, McCans J, de Guise P, Juneau M. Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation 1993;88(5, pt 1):2045-2048 [PubMed] [Google Scholar]

136. Rich JD, Maraganore JM, Young E, et al. Heparin resistance in acute coronary syndromes. J Thromb Thrombolysis 2007April;23(2):93-100 Epub 2007 Jan 13 [PubMed] [Google Scholar]

137. Warkentin TE, Kelton JG. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann Intern Med. 2001;135(7):502-506 [PubMed] [Google Scholar]

138. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995;332(20):1330-1335 [PubMed] [Google Scholar]

139. Antman EM, Cohen M, Radley D, et al. Assessment of the treatment effect of enoxaparin for unstable Angina/Non-Q-wave myocardial infarction: TIMI 11B-ESSENCE meta-analysis. Circulation 1999;100(15):1602-1608 [PubMed] [Google Scholar]

140. Ferguson JJ, Califf RM, Antman EM, et al.SYNERGY Trial Investigators Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA 2004;292(1):45-54 [PubMed] [Google Scholar]

141. de Lemos JA, Blazing MA, Wiviott SD, et al.A to Z Investigators Enoxaparin versus unfractionated heparin in patients treated with tirofiban, aspirin and an early conservative initial management strategy: results from the A phase of the A-to-Z trial. Eur Heart J. 2004;25(19):1688-1694 [PubMed] [Google Scholar]

142. Antman EM, McCabe CH, Gurfinkel EP, et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction: results of the Thrombolysis In Myocardial Infarction (TIMI) 11B trial. Circulation 1999;100(15):1593-1601 [PubMed] [Google Scholar]

143. de Lemos JA, Rifai N, Morrow DA, et al. Elevated baseline myoglobin is associated with increased mortality in acute coronary syndromes, even among patients with normal baseline troponin I: a TIMI 11B substudy. Circulation 1999;100(suppl I):I372-I373 [Google Scholar]

144. Stone GW, McLaurin BT, Cox DA, et al.ACUITY Investigators Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355(21):2203-2216 [PubMed] [Google Scholar]

145. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006April6;354(14):1464-1476 Epub 2006 Mar 14 [PubMed] [Google Scholar]

146. Organization to Assess Strategies for Ischemic Syndromes (OASIS) Investigators Effects of long-term, moderate-intensity oral anticoagulation in addition to aspirin in unstable angina. J Am Coll Cardiol. 2001;37(2):475-484 [PubMed] [Google Scholar]

147. van Es RF, Jonker JJC, Verheugt FWA, Deckers JW, Grobbee DE, Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2 (ASPECT-2) Research Group Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Lancet 2002;360(9327):109-113 [PubMed] [Google Scholar]

148. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med. 2002;347(13):969-974 [PubMed] [Google Scholar]

149. Grundy SM, Cleeman JI, Bairey Merz CN, et al.Coordinating Committee of the National Cholesterol Education Program Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines [published correction appears in Circulation. 2004;110(6):763] Circulation 2004;110(2):227-239 [PubMed] [Google Scholar]

150. Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349-1357 [PubMed] [Google Scholar]

151. Cannon CP, Braunwald E, McCabe CH, et al.Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators Intensive versus moderate lipid lowering with statins after acute coronary syndromes [published correction appears in N Engl J Med. 2006;354(7):778] N Engl J Med. 2004April8;350(15):1495-1504 Epub 2004 Mar 8 [PubMed] [Google Scholar]

152. Ridker PM, Cannon CP, Morrow D, et al.Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22. (PROVE IT-TIMI 22) Investigators C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005;352(1):20-28 [PubMed] [Google Scholar]

What are the most correct characteristics of chest pain in patient with acute coronary syndrome?

What is considered acute coronary syndrome?

Which of the following is the most appropriate response when a patient with chest pain?

What is the most common cause of acute coronary syndrome?