{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:45:24Z","timestamp":1790383524494,"version":"4.1.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,9,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients who have had an acute coronary syndrome (\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              ) are at increased risk of recurrent cardiovascular events; however, paradoxically, high\u2010risk patients who may derive the greatest benefit from guideline\u2010recommended therapies are often undertreated. The aim of our study was to examine the management, clinical outcomes, and temporal trends of patients after\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              stratified by the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention, a recently validated clinical tool that incorporates 9 clinical risk factors.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Included were patients with\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (\n              <jats:styled-content style=\"fixed-case\">ACSIS<\/jats:styled-content>\n              ) between 2008 and 2016. Patients were stratified by the TIMI risk score for secondary prevention to\n              <jats:italic>low<\/jats:italic>\n              (score 0\u20131),\n              <jats:italic>intermediate<\/jats:italic>\n              (2), or\n              <jats:italic>high<\/jats:italic>\n              (\u22653) risk. Clinical outcomes included 30\u2010day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1\u2010year mortality. Of 6827\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              patients enrolled, 35% were low risk, 27% were intermediate risk, and 38% were high risk. Compared with the other risk groups, high\u2010risk patients were older, were more commonly female, and had more renal dysfunction and heart failure (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 for each). High\u2010risk patients were treated less commonly with guideline\u2010recommended therapies during hospitalization (percutaneous coronary intervention) and at discharge (statins, dual\u2010antiplatelet therapy, cardiac rehabilitation). Overall, high\u2010risk patients had higher rates of 30\u2010day major adverse cardiac events (7.2% low, 8.2% intermediate, and 15.1% high risk;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and 1\u2010year mortality (1.9%, 4.6%, and 15.8%, respectively;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Over the past decade, utilization of guideline\u2010recommended therapies has increased among all risk groups; however, the rate of 30\u2010day major adverse cardiac events has significantly decreased among patients at high risk but not among patients at low and intermediate risk. Similarly, the 1\u2010year mortality rate has decreased numerically only among high\u2010risk patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Despite an improvement in the management of high\u2010risk\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              patients, they are still undertreated with guideline\u2010recommended therapies. Nevertheless, the outcome of high\u2010risk patients after\n              <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\n              has significantly improved in the past decade, thus they should not be denied these therapies.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009885","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T15:02:17Z","timestamp":1537110137000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Guideline\u2010Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome"],"prefix":"10.1161","volume":"7","author":[{"given":"Yoav","family":"Hammer","sequence":"first","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaza","family":"Iakobishvili","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hasdai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"The Leviev Heart Center Sheba Medical Center Tel Hashomer Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"},{"name":"Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Shlomo","sequence":"additional","affiliation":[{"name":"Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Einhorn","sequence":"additional","affiliation":[{"name":"Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamir","family":"Bental","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Witberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Kornowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Eisen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rabin Medical Center Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3181a84613"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.852749"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)11181-9"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60503-1"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04560-8"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909475"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199209033271001"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032292"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040583"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1410489"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000112577.69066.CB"},{"key":"e_1_3_1_14_2","first-page":"CD011273","article-title":"Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews","volume":"12","author":"Anderson L","year":"2014","unstructured":"Anderson L, Taylor RS. 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