We Must Use the Knowledge That We Have to Treat Patients With Acute Coronary Syndromes

Numerous registries have shown that evidence-basedtherapies are often not prescribed despite strongevidence that they reduce mortality and morbidity.1 In this edition of the journal, Mukherjee et al2 describe the use of a composite appropriateness score to assess the potential effect of evidence-based therapies on 6-month mortality in 1358 consecutive patients presenting with an acute coronary syndrome (ACS). Fifteen percent of these patients had ST-elevation myocardial infarction (MI), 55 % had non–ST-elevation MI, and 30 % had unstable angina. Most were in Killip class I or II, and 48 % underwent either percutaneous coronary intervention or coronary artery bypass grafting while in the hospital. The study found that the use of antiplatelet therapy, statins, angiotensin-converting enzyme (ACE) inhibitors, and -blockers had apparently additive effects in reducing 6-month mortality. There was also a strong trend (P0.08) toward increased survival in patient