Issues in cardiac intervention for UA/NSTEMI
1 Sheba Medical Center, Tel-Hashomer, Israel
2 Baylor College of Medicine, Houston, Texas, USA
3 Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
4 Helsinki University Central Hospital, Helsinki, Finland
* Correspondence: Hanoch H. Hod, Sheba Medical Center, Tel-Hashomer, Israel.
Abstract
The ACC/AHA and the ESC have recently developed new treatment guidelines for the management of unstable angina and non-ST-segment elevation myocardial infarction, and both documents make recommendations with regard to interventional management. At the 4th Annual Experts' Meeting of the International Cardiology Forum, workshops were held to discuss the evidence supporting these recommendations, the applicability of the guidelines to clinical practice in different countries and institutional settings, and areas where more research is required. Although both sets of guidelines were generally well received, workshop participants disagreed on a number of issues. Opinion was divided as to the specific risk-factors that should mandate early catheterization, and the optimal timing of intervention following the initial presentation. Further clinical trials addressing these questions are needed. However, in many parts of the world, interventional strategies are influenced by external constraints, including shortage of facilities or limitations on length of hospital stay, which may limit the applicability of clinical evidence.
Key Words: Unstable angina • percutaneous coronary intervention • angioplasty • coronary artery bypass graft • guidelines
References
- Bertrand ME, Simoons ML, Fox KAA, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology. (chair)Eur Heart J. 2000;21:1406–1432
[Free Full Text] - The TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Circulation. 1994;89:1545–1556
[Abstract/Free Full Text] - Boden WE, O'Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. The Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998;338:1785–1792
[Abstract/Free Full Text] - Fragmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet. 1999;354:708–715[CrossRef][Web of Science][Medline]
- McCullough PA, O'Neill WW, Graham M, et al. A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Results of the Medicine versus Angiography in Thrombolytic Exclusion (MATE) trial. J Am Coll Cardiol. 1998;32:596–605
[Abstract/Free Full Text] - Yusuf S, Flather M, Pogue J, et al. Variations between countries in invasive cardiac proceures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation. OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators. Lancet. 1998;352:507–514[CrossRef][Web of Science][Medline]
- Ghazzal P, Chalasani Y, Weintraub WS. Long term outcome of patients with non-Q wave myocardial infarction with or without revascularization. (abstract)J Am Coll Cardiol. 1998;31:14A (Suppl)
- Roe MT, Lauer MA, Houghtaling P, et al. An ischaemia-guided strategy of cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes may be associated with improved outcomes. (abstract)J Am Coll Cardiol. 1999;33:391A (Suppl)
- Berdan LG, Kleiman NS, Guerci A, et al. Unstable angina in the U.S.: patients and management. (abstract)Circulation. 1998;98:1–359 (Suppl)
[Abstract/Free Full Text] - Fox KAA. Management of high-risk unstable angina and non-ST-elevation myocardial infarction: variations in practice. The Global Registry of Acute Coronary Events. (abstract)Eur Heart J. 2000;21:246 (Suppl)
- The EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med. 1997;336:1689–1696
[Abstract/Free Full Text] - Cannon CP, Weintraub WS, Demopoulos LA, Robertson DH, Gormley GJ, Braunwald E. Invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction following treatment with tirofiban: rationale and study design of the international TACTICS-TIMI 18 Trial. Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy. Thrombolysis In Myocardial Infarction. Am J Cardiol. 1998;82:731–736[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||