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The “treatment-risk paradox” is a situation in which patients at high risk for adverse events receive less-intensive treatment than do patients at lower risk. In two recent studies, investigators explored this curious pattern in the treatment of cardiovascular conditions.
The first study involved 4414 patients in two multicenter Canadian Acute Coronary Syndromes registries who were hospitalized for non-ST segment elevation MI (NSTEMI) either before the release of updated (2002) ACC/AHA guidelines for managing patients with NSTEMI (September 1999–June 2001) or shortly thereafter (October 2002–December 2003). Using the GRACE risk score, investigators stratified patients according to their risk for in-hospital mortality, then assessed rates of …