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October 15, 2008

The Disconnect Between Practice Guidelines and Clinical Practice—Stressed Out

Author Affiliations

Author Affiliations: Division of Cardiology, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, University of California, Los Angeles.

JAMA. 2008;300(15):1817-1819. doi:10.1001/jama.300.15.1817

Despite increasing evidence supporting plaque instability as the proximate cause of atherosclerotic events,1,2 treatment strategies continue to focus on the anatomic stenosis.3 This preoccupation with coronary luminology causes clinicians to perform stress tests and angiograms to identify flow-limiting lesions, even among asymptomatic patients, and to mitigate the effects of these lesions by direct mechanical or surgical intervention. As a result, clinical practice guidelines currently recommend revascularization when stress testing reveals demonstrable myocardial ischemia despite optimal medical management.3,4

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