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Aspirin, Clopidogrel, and Ticagrelor in Acute Coronary Syndromes

      Dual antiplatelet therapy is the cornerstone in the management of patients with acute coronary syndromes (ACS). Ticagrelor, an oral, direct, reversibly binding, P2Y12 receptor antagonist, is approved for the prevention of atherothrombotic events in adult patients with ACS. In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was associated with significant reductions in cardiovascular events, cardiovascular mortality, and all-cause mortality compared with clopidogrel. A subanalysis of PLATO trial data identified a geographic region interaction (p = 0.045), indicating reduced efficacy of ticagrelor versus clopidogrel in North American patients. This effect could be due to chance, but may be explained by an interaction of ticagrelor with high aspirin doses, which are commonly used in the United States. In patients taking low-dose maintenance aspirin, ticagrelor was more effective than clopidogrel in decreasing cardiovascular events regardless of the geographic region. A proposed hypothetical mechanism for the interaction between ticagrelor and higher aspirin dose is linked to the level of P2Y12 inhibition and the potential prothrombotic effects of high-dose aspirin through the suppression of prostacyclin. A review of data regarding aspirin use for secondary prevention of events in ACS demonstrated that low aspirin doses (75 to 160 mg/day) are consistently favored for short- and long-term use because of the lack of a dose-response relationship between increasing aspirin dose and improved efficacy, and a higher incidence of gastrointestinal bleeding with increasing aspirin dose. The use of low aspirin doses reflects good clinical practice and is encouraged in current guidelines.
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      References

        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • Adams R.J.
        • Berry J.D.
        • Brown T.M.
        • Carnethon M.R.
        • Dai S.
        • de Simone G.
        • Ford E.S.
        • Fox C.S.
        • Fullerton H.J.
        • Gillespie C.
        • Greenlund K.J.
        • Hailpern S.M.
        • Heit J.A.
        • Ho P.M.
        • Howard V.J.
        • Kissela B.M.
        • Kittner S.J.
        • Lackland D.T.
        • Lichtman J.H.
        • Lisabeth L.D.
        • Makuc D.M.
        • Marcus G.M.
        • Marelli A.
        • Matchar D.B.
        • McDermott M.M.
        • Meigs J.B.
        • Moy C.S.
        • Mozaffarian D.
        • Mussolino M.E.
        • Nichol G.
        • Paynter N.P.
        • Rosamond W.D.
        • Sorlie P.D.
        • Stafford R.S.
        • Turan T.N.
        • Turner M.B.
        • Wong N.D.
        • Wylie-Rosett J.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics–2011 update: a report from the American Heart Association.
        Circulation. 2011; 123: e18-e209
        • Davì G.
        • Patrono C.
        Platelet activation and atherothrombosis.
        N Engl J Med. 2007; 357: 2482-2494
        • Eikelboom J.W.
        • Hirsh J.
        • Spencer F.A.
        • Baglin T.P.
        • Weitz J.I.
        Antiplatelet drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: e89S-e119S
        • Vandvik P.O.
        • Lincoff A.M.
        • Gore J.M.
        • Gutterman D.D.
        • Sonnenberg F.A.
        • Alonso-Coello P.
        • Akl E.A.
        • Lansberg M.G.
        • Guyatt G.H.
        • Spencer F.A.
        Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: e637S-e668S
        • Hamm C.W.
        • Bassand J.P.
        • Agewall S.
        • Bax J.
        • Boersma E.
        • Bueno H.
        • Caso P.
        • Dudek D.
        • Gielen S.
        • Huber K.
        • Ohman M.
        • Petrie M.C.
        • Sonntag F.
        • Uva M.S.
        • Storey R.F.
        • Wijns W.
        • Zahger D.
        • ESC Committee for Practice Guidelines
        • Bax J.J.
        • Auricchio A.
        • Baumgartner H.
        • Ceconi C.
        • Dean V.
        • Deaton C.
        • Fagard R.
        • Funck-Brentano C.
        • Hasdai D.
        • Hoes A.
        • Knuuti J.
        • Kolh P.
        • McDonagh T.
        • Moulin C.
        • Poldermans D.
        • Popescu B.A.
        • Reiner Z.
        • Sechtem U.
        • Sirnes P.A.
        • Torbicki A.
        • Vahanian A.
        • Windecker S.
        • Document Reviewers
        • Windecker S.
        • Achenbach S.
        • Badimon L.
        • Bertrand M.
        • Bøtker H.E.
        • Collet J.P.
        • Crea F.
        • Danchin N.
        • Falk E.
        • Goudevenos J.
        • Gulba D.
        • Hambrecht R.
        • Herrmann J.
        • Kastrati A.
        • Kjeldsen K.
        • Kristensen S.D.
        • Lancellotti P.
        • Mehilli J.
        • Merkely B.
        • Montalescot G.
        • Neumann F.J.
        • Neyses L.
        • Perk J.
        • Roffi M.
        • Romeo F.
        • Ruda M.
        • Swahn E.
        • Valgimigli M.
        • Vrints C.J.
        • Widimsky P.
        ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2011; 32: 2999-3054
        • Jneid H.
        • Anderson J.L.
        • Wright R.S.
        • Adams C.D.
        • Bridges C.R.
        • Casey D.E.
        • Ettinger S.M.
        • Fesmire F.M.
        • Ganiats T.G.
        • Lincoff A.M.
        • Peterson E.D.
        • Philippides G.J.
        • Theroux P.
        • Wenger N.K.
        • Zidar J.P.
        2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
        J Am Coll Cardiol. 2012; 60: 645-681
        • Van de Werf F.
        • Bax J.
        • Betriu A.
        • Blomstrom-Lundqvist C.
        • Crea F.
        • Falk V.
        • Filippatos G.
        • Fox K.
        • Huber K.
        • Kastrati A.
        • Rosengren A.
        • Steg P.G.
        • Tubaro M.
        • Verheugt F.
        • Weidinger F.
        • Weis M.
        • ESC Committee for Practice Guidelines (CPG)
        Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology.
        Eur Heart J. 2008; 29: 2909-2945
        • Kushner F.G.
        • Hand M.
        • Smith Jr., S.C.
        • King 3rd, S.B.
        • Anderson J.L.
        • Antman E.M.
        • Bailey S.R.
        • Bates E.R.
        • Blankenship J.C.
        • Casey Jr., D.E.
        • Green L.A.
        • Hochman J.S.
        • Jacobs A.K.
        • Krumholz H.M.
        • Morrison D.A.
        • Ornato J.P.
        • Pearle D.L.
        • Peterson E.D.
        • Sloan M.A.
        • Whitlow P.L.
        • Williams D.O.
        • American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines
        2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
        Circulation. 2009; 120: 2271-2306
        • Guyatt G.H.
        • Akl E.A.
        • Crowther M.
        • Gutterman D.D.
        • Schunemann H.J.
        • American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel
        Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: 7S-47S
        • Fox K.A.
        • Steg P.G.
        • Eagle K.A.
        • Goodman S.G.
        • Anderson Jr., F.A.
        • Granger C.B.
        • Flather M.D.
        • Budaj A.
        • Quill A.
        • Gore J.M.
        • GRACE Investigators
        Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006.
        JAMA. 2007; 297: 1892-1900
        • Roth G.J.
        • Majerus P.W.
        The mechanism of the effect of aspirin on human platelets. I. Acetylation of a particulate fraction protein.
        J Clin Invest. 1975; 56: 624-632
        • Patrono C.
        • García Rodríguez L.A.
        • Landolfi R.
        • Baigent C.
        Low-dose aspirin for the prevention of atherothrombosis.
        N Engl J Med. 2005; 353: 2373-2383
        • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group
        Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2.
        Lancet. 1988; 2: 349-360
        • Baigent C.
        • Blackwell L.
        • Collins R.
        • Emberson J.
        • Godwin J.
        • Peto R.
        • Buring J.
        • Hennekens C.
        • Kearney P.
        • Meade T.
        • Patrono C.
        • Roncaglioni M.C.
        • Zanchetti A.
        • Antithrombotic Trialists' (ATT) Collaboration
        Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.
        Lancet. 2009; 373: 1849-1860
        • Biondi-Zoccai G.G.
        • Lotrionte M.
        • Agostoni P.
        • Abbate A.
        • Fusaro M.
        • Burzotta F.
        • Testa L.
        • Sheiban I.
        • Sangiorgi G.
        A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease.
        Eur Heart J. 2006; 27: 2667-2674
        • Kong D.F.
        • Hasselblad V.
        • Kandzari D.E.
        • Newby L.K.
        • Califf R.M.
        Seeking the optimal aspirin dose in acute coronary syndromes.
        Am J Cardiol. 2002; 90: 622-625
        • Campbell C.L.
        • Smyth S.
        • Montalescot G.
        • Steinhubl S.R.
        Aspirin dose for the prevention of cardiovascular disease: a systematic review.
        JAMA. 2007; 297: 2018-2024
        • Patrono C.
        • Baigent C.
        • Hirsh J.
        • Roth G.
        • American College of Chest Physicians
        Antiplatelet drugs: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition).
        Chest. 2008; 133: 199S-233S
        • Herbert J.M.
        • Savi P.
        P2Y12, a new platelet ADP receptor, target of clopidogrel.
        Semin Vasc Med. 2003; 3: 113-122
        • Wiviott S.D.
        • Antman E.M.
        • Braunwald E.
        Prasugrel.
        Circulation. 2010; 122: 394-403
        • Clarke T.A.
        • Waskell L.A.
        The metabolism of clopidogrel is catalyzed by human cytochrome P450 3A and is inhibited by atorvastatin.
        Drug Metab Dispos. 2003; 31: 53-59
      1. Plavix (clopidogrel) prescribing information. Available at: http://products.sanofi.us/plavix/plavix.html (last accessed March 14, 2012).

      2. Plavix (clopidogrel) summary of product characteristics. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000174/WC500042189.pdf (last accessed March 14, 2012).

        • Yusuf S.
        • Zhao F.
        • Mehta S.R.
        • Chrolavicius S.
        • Tognoni G.
        • Fox K.K.
        • 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.
        N Engl J Med. 2001; 345: 494-502
        • Peters R.J.
        • Mehta S.R.
        • Fox K.A.
        • Zhao F.
        • Lewis B.S.
        • Kopecky S.L.
        • Diaz R.
        • Commerford P.J.
        • Valentin V.
        • Yusuf S.
        • Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators
        Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study.
        Circulation. 2003; 108: 1682-1687
        • Sabatine M.S.
        • Cannon C.P.
        • Gibson C.M.
        • López-Sendón J.L.
        • Montalescot G.
        • Theroux P.
        • Claeys M.J.
        • Cools F.
        • Hill K.A.
        • Skene A.M.
        • McCabe C.H.
        • Braunwald E.
        • CLARITY-TIMI 28 Investigators
        Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation.
        N Engl J Med. 2005; 352: 1179-1189
        • Chen Z.M.
        • Jiang L.X.
        • Chen Y.P.
        • Xie J.X.
        • Pan H.C.
        • Peto R.
        • Collins R.
        • Liu L.S.
        • COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group
        Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial.
        Lancet. 2005; 366: 1607-1621
        • Wiviott S.D.
        • Braunwald E.
        • McCabe C.H.
        • Montalescot G.
        • Ruzyllo W.
        • Gottlieb S.
        • Neumann F.J.
        • Ardissino D.
        • De Servi S.
        • Murphy S.A.
        • Riesmeyer J.
        • Weerakkody G.
        • Gibson C.M.
        • Antman E.M.
        • TRITON-TIMI 38 Investigators
        Prasugrel versus clopidogrel in patients with acute coronary syndromes.
        N Engl J Med. 2007; 357: 2001-2015
      3. Effient (prasugrel) prescribing information. Available at: http://pi.lilly.com/us/effient.pdf (last accessed March 14, 2012).

      4. Effient (prasugrel) summary of product characteristics. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000984/WC500021971.pdf (last accessed March 14, 2012).

      5. Eli Lilly and Company. Cardiovascular and Renal Drugs Advisory Committee briefing document. Effient (Prasugrel). Acute coronary syndromes managed by percutaneous coronary intervention. Available at: http://www.fda.gov/ohrms/dockets/ac/09/briefing/2009-4412b1-03-Lilly.pdf (last accessed October 12, 2012).

        • Van Giezen J.J.
        • Nilsson L.
        • Berntsson P.
        • Wissing B.M.
        • Giordanetto F.
        • Tomlinson W.
        • Greasley P.J.
        Ticagrelor binds to human P2Y(12) independently from ADP but antagonizes ADP-induced receptor signaling and platelet aggregation.
        J Thromb Haemost. 2009; 7: 1556-1565
        • Husted S.
        • van Giezen J.J.
        Ticagrelor: the first reversibly binding oral P2Y12 receptor antagonist.
        Cardiovasc Ther. 2009; 27: 259-274
      6. Brilinta (ticagrelor) prescribing information. Available at: http://www1.astrazeneca-us.com/pi/brilinta.pdf (last accessed March 13, 2012).

      7. Brilique (ticagrelor) summary of product characteristics. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001241/WC500100494.pdf (last accessed March 13, 2012).

        • Wallentin L.
        • Becker R.C.
        • Budaj A.
        • Cannon C.P.
        • Emanuelsson H.
        • Held C.
        • Horrow J.
        • Husted S.
        • James S.
        • Katus H.
        • Mahaffey K.W.
        • Scirica B.M.
        • Skene A.
        • Steg P.G.
        • Storey R.F.
        • Harrington R.A.
        • PLATO Investigators
        • Freij A.
        • Thorsén M.
        Ticagrelor versus clopidogrel in patients with acute coronary syndromes.
        N Engl J Med. 2009; 361: 1045-1057
        • Mahaffey K.W.
        • Wojdyla D.M.
        • Carroll K.
        • Becker R.C.
        • Storey R.F.
        • Angiolillo D.J.
        • Held C.
        • Cannon C.P.
        • James S.
        • Pieper K.S.
        • Horrow J.
        • Harrington R.A.
        • Wallentin L.
        • PLATO Investigators
        Ticagrelor compared with clopidogrel by geographic region in the platelet inhibition and patient outcomes (PLATO) trial.
        Circulation. 2011; 124: 544-554
        • James S.
        • Åkerblom A.
        • Cannon C.P.
        • Emanuelsson H.
        • Husted S.
        • Katus H.
        • Skene A.
        • Steg P.G.
        • Storey R.F.
        • Harrington R.
        • Becker R.
        • Wallentin L.
        Comparison of ticagrelor, the first reversible oral P2Y12 receptor antagonist, with clopidogrel in patients with acute coronary syndromes: rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial.
        Am Heart J. 2009; 157: 599-605
        • Antiplatelet Trialists' Collaboration
        Secondary prevention of vascular disease by prolonged antiplatelet treatment.
        Br Med J (Clin Res Ed). 1988; 296: 320-331
        • Roderick P.J.
        • Wilkes H.C.
        • Meade T.W.
        The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials.
        Br J Clin Pharmacol. 1993; 35: 219-226
        • Antiplatelet Trialists' Collaboration
        Collaborative overview of randomised trials of antiplatelet therapy–I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.
        BMJ. 1994; 308: 81-106
        • Antithrombotic Trialists' Collaboration
        Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.
        BMJ. 2002; 324: 71-86
        • Bhatt D.L.
        • Scheiman J.
        • Abraham N.S.
        • Antman E.M.
        • Chan F.K.
        • Furberg C.D.
        • Johnson D.A.
        • Mahaffey K.W.
        • Quigley E.M.
        • American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents
        ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents.
        Circulation. 2008; 118: 1894-1909
        • Lee M.
        • Cryer B.
        • Feldman M.
        Dose effects of aspirin on gastric prostaglandins and stomach mucosal injury.
        Ann Intern Med. 1994; 120: 184-189
        • CURRENT-OASIS 7 Investigators
        Dose comparisons of clopidogrel and aspirin in acute coronary syndromes.
        N Engl J Med. 2010; 363: 930-942
        • Berger J.S.
        • Stebbins A.
        • Granger C.B.
        • Ohman E.M.
        • Armstrong P.W.
        • Van de Werf F.
        • White H.D.
        • Simes R.J.
        • Harrington R.A.
        • Califf R.M.
        • Peterson E.D.
        Initial aspirin dose and outcome among ST-elevation myocardial infarction patients treated with fibrinolytic therapy.
        Circulation. 2008; 117: 192-199
        • Patrignani P.
        • Filabozzi P.
        • Patrono C.
        Selective cumulative inhibition of platelet thromboxane production by low-dose aspirin in healthy subjects.
        J Clin Invest. 1982; 69: 1366-1372
        • Berger J.S.
        • Lala A.
        • Krantz M.J.
        • Baker G.S.
        • Hiatt W.R.
        Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials.
        Am Heart J. 2011; 162: 115-124
        • Awtry E.H.
        • Loscalzo J.
        Aspirin.
        Circulation. 2000; 101: 1206-1218
        • Tickoo S.
        • Roe M.T.
        • Peterson E.D.
        • Milford-Beland S.
        • Ohman E.M.
        • Gibler W.B.
        • Pollack Jr., C.V.
        • Cannon C.P.
        • CRUSADE Investigators
        Patterns of aspirin dosing in non-ST-elevation acute coronary syndromes in the CRUSADE Quality Improvement Initiative.
        Am J Cardiol. 2007; 99: 1496-1499
        • Jolly S.S.
        • Pogue J.
        • Haladyn K.
        • Peters R.J.
        • Fox K.A.
        • Avezum A.
        • Gersh B.J.
        • Rupprecht H.J.
        • Yusuf S.
        • Mehta S.R.
        Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study.
        Eur Heart J. 2009; 30: 900-907
      8. AstraZeneca. Ticagrelor NDA 22-433 briefing document for cardiovascular and renal drug advisory committee meeting. Available at: http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/cardiovascularandrenaldrugsadvisorycommittee/ucm220197.pdf (last accessed October 12, 2012).

        • Warner T.D.
        • Nylander S.
        • Whatling C.
        Anti-platelet therapy: cyclooxygenase inhibition and the use of aspirin with particular regard to dual anti-platelet therapy.
        Br J Clin Pharmacol. 2011; 72: 619-633
        • Kirkby N.S.
        • Leadbeater P.D.
        • Chan M.V.
        • Nylander S.
        • Mitchell J.A.
        • Warner T.D.
        Anti-platelet effects of aspirin vary with level of P2Y(12) receptor blockade supplied by either ticagrelor or prasugrel.
        J Thromb Haemost. 2011; 9: 2103-2105
        • Gislason G.H.
        • Jacobsen S.
        • Rasmussen J.N.
        • Rasmussen S.
        • Buch P.
        • Friberg J.
        • Schramm T.K.
        • Abildstrom S.Z.
        • Køber L.
        • Madsen M.
        • Torp-Pedersen C.
        Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs after acute myocardial infarction.
        Circulation. 2006; 113: 2906-2913
        • Armstrong P.C.
        • Leadbeater P.D.
        • Chan M.V.
        • Kirkby N.S.
        • Jakubowski J.A.
        • Mitchell J.A.
        • Warner T.D.
        In the presence of strong P2Y12 receptor blockade, aspirin provides little additional inhibition of platelet aggregation.
        J Thromb Haemost. 2011; 9: 552-561
        • Wright R.S.
        • Anderson J.L.
        • Adams C.D.
        • Bridges C.R.
        • Casey Jr., D.E.
        • Ettinger S.M.
        • Fesmire F.M.
        • Ganiats T.G.
        • Jneid H.
        • Lincoff A.M.
        • Peterson E.D.
        • Philippides G.J.
        • Theroux P.
        • Wenger N.K.
        • Zidar J.P.
        • Jacobs A.K.
        2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2011; 123: 2022-2060
        • Antman E.M.
        • Anbe D.T.
        • Armstrong P.W.
        • Bates E.R.
        • Green L.A.
        • Hand M.
        • Hochman J.S.
        • Krumholz H.M.
        • Kushner F.G.
        • Lamas G.A.
        • Mullany C.J.
        • Ornato J.P.
        • Pearle D.L.
        • Sloan M.A.
        • Smith Jr., S.C.
        • Alpert J.S.
        • Anderson J.L.
        • Faxon D.P.
        • Fuster V.
        • Gibbons R.J.
        • Gregoratos G.
        • Halperin J.L.
        • Hiratzka L.F.
        • Hunt S.A.
        • Jacobs A.K.
        • Ornato J.P.
        ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction).
        J Am Coll Cardiol. 2004; 44: E1-E211