Contemporary treatment of unstable angina and non-ST-segment-elevation myocardial infarction (part 2).

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  • Author(s): Sami S;Sami S; Willerson JT
  • Source:
    Texas Heart Institute journal [Tex Heart Inst J] 2010; Vol. 37 (3), pp. 262-75.
  • Publication Type:
    Journal Article; Review
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute Country of Publication: United States NLM ID: 8214622 Publication Model: Print Cited Medium: Internet ISSN: 1526-6702 (Electronic) Linking ISSN: 07302347 NLM ISO Abbreviation: Tex Heart Inst J Subsets: MEDLINE
    • Publication Information:
      Original Publication: Houston, TX : published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute, c1982-
    • Subject Terms:
    • Abstract:
      In Part 1 of this review, we discussed how plaque rupture is the most common underlying cause of most cases of unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI) and how early risk stratification is vital for the timely diagnosis and treatment of acute coronary syndromes (ACS). Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI. In summary, ACS involving UA/NSTEMI is associated with high rates of adverse cardiovascular events, despite recent therapeutic advances. Plaque composition and inflammation are more important in the pathogenesis of ACS than is the actual degree of arterial stenosis. As results from new trials challenge our current practices and help us develop the optimal treatment strategy for UA/NSTEMI patients, the cornerstones of contemporary treatment remain early risk stratification and aggressive medical therapy, supplemented by coronary angiography in appropriately selected patients. An early-invasive-treatment strategy is of most benefit to high-risk patients, whereas an early-conservative strategy is recommended for low-risk patients. Adjunctive medical therapy with acetylsalicylic acid, clopidogrel or another adenosine diphosphate antagonist, glycoprotein IIb/IIIa inhibitors, and either low-molecular-weight heparin or unfractionated heparin, in the appropriate setting, further reduces the risk of ischemic events secondary to thrombosis. Short- and long-term inhibition of platelet aggregation should be achieved by appropriately evaluating the risk of bleeding complications in these patients.
    • Number of References:
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    • Contributed Indexing:
      Keywords: Abciximab; acute coronary syndrome/therapy; angina pectoris; angina, unstable/drug therapy/therapy; angioplasty, transluminal, percutaneous coronary; angiotensin-converting enzyme inhibitors; aspirin/administration & dosage; calcium channel blockers; clinical trial as topic; clopidogrel; dalteparin; drug therapy, combination; enoxaparin; eptifibatide; evidence-based medicine; fondaparinux; heparin; immunoglobulin Fab fragments; meta-analysis as topic; multicenter study as topic; multivariate analysis; myocardial infarction; myocardial revascularization; nitroglycerin/therapeutic use; platelet aggregation inhibitors; platelet glycoprotein GPIIb-IIIa complex; prodrugs/therapeutic use; proton pumps; randomized controlled trials as topic; review; risk assessment; stents; thrombolytic therapy; ticlopidine; treatment outcome; vasodilator agents
    • Accession Number:
      0 (Anticoagulants)
      0 (Platelet Aggregation Inhibitors)
    • Publication Date:
      Date Created: 20100616 Date Completed: 20100927 Latest Revision: 20211020
    • Publication Date:
      20240104
    • Accession Number:
      PMC2879200
    • Accession Number:
      20548800