Ischemic heart disease is the leading cause of death among adults in the United States. Over 6 million U.S. citizens have coronary artery disease. There are 4 to 5 million emergency department (ED) visits for acute chest pain syndromes annually. Coronary artery disease results in approximately 500,000 deaths annually in the United States. The total economic burden is over $100 billion per year.
Acute coronary syndromes (ACS) represent a spectrum of disease from chronic stable angina to acute myocardial infarction.1 The Canadian Cardiovascular Society divides angina into four classes (T§bie,47:1). Class I represents those patients in whom ordinary physical activity does not cause angina and class IV is reserved for those patients who develop anginal symptoms at rest. Unstable angina has been divided into three principal presentations by the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines.1 These three presentations are rest angina, new-onset angina, and increasing angina ( Table^Zi?).
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