Background: The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) increases the likelihood of significant coronary artery disease (CAD). The impact of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories ("polyvascular" disease) in patients presenting with non-ST elevation acute coronary syndromes (ACS) has not been well studied.. Methods: A total of 95,749 patients enrolled from February 15, 2003 to September 30, 2006 at 484 sites in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry were analyzed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction (MI), stroke, and congestive (CHF) were analyzed, as were the rates of non-bypass surgery red blood cell transfusions.. Results: On presentation, a total of 11,345 (11.9%) patients had established PAD, ...
The American College of Cardiology and the American Heart Association (ACC/AHA) have issued an update to their Unstable Angina/ Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) guidelines, last published in 2002.
TY - JOUR. T1 - Pentraxin 3 in unstable angina and non-ST-segment elevation myocardial infarction. AU - Matsui, Shigeru. AU - Ishii, Junichi. AU - Kitagawa, Fumihiko. AU - Kuno, Atsuhiro. AU - Hattori, Kousuke. AU - Ishikawa, Makoto. AU - Okumura, Masanori. AU - Kan, Shino. AU - Nakano, Tadashi. AU - Naruse, Hiroyuki. AU - Tanaka, Ikuko. AU - Nomura, Masanori. AU - Hishida, Hitoshi. AU - Ozaki, Yukio. PY - 2010/5/1. Y1 - 2010/5/1. N2 - Purpose: We prospectively investigated the prognostic value of pentraxin 3 (PTX3) in patients with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI). Background: PTX3 may be a useful marker for localized vascular inflammation and damage to the cardiovascular system. Recent studies have shown that plasma PTX3 is elevated in patients with UA/NSTEMI; however, its prognostic value in UA/NSTEMI remains unclear. Methods: PTX3, high-sensitivity C-reactive protein (hsCRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac ...
It has long been recognized that coronary artery disease comprises a wide spectrum of conditions, ranging from chronic stable angina to acute myocardial infarction. Unstable angina, in the middle of this spectrum is a heterogeneous syndrome with widely variable symptoms and prognosis. In 1989, a classification of unstable angina was introduced1 ; this classification is based on the clinical history (accelerated exertional angina or rest pain, the timing of the latter in respect to presentation, and the clinical circumstances in which unstable angina developed), on the presence or absence of ECG changes, and on the intensity of anti-ischemic therapy.. Although the development of this classification was based on clinical experience, it has been validated in a number of prospective studies. For example, Calvin et al2 studied 393 patients with unstable angina and reported that a history of a myocardial infarction within 14 days (class C) and ST-segment depression on the presenting ECG were both ...
This study sought to identify differences in coronary anatomic pathology in patients with unstable angina and elevated versus nonelevated serum troponin T values. Previous studies have shown a worse prognosis in unstable angina patients with elevated
Video 24.8. Acute pulmonary embolism. TTE. Note dilated right heart with McConnells sign and paradoxical septal movements in a patient referred to the ER from the regional hospital due to suspected unstable angina. Echo-free space in front of the heart represents pericardial fat pad. Reproduced from Chapter 24: Echocardiography in the emergency room, in The EAE Textbook of Echocardiography. Edited by Leda Galiuto, Luigi Badano, Kevin Fox, Rosa Sicari, and Jose Luis Zamorano. © European Society of Cardiology. DOI: 10.1093/med/9780199599639.001.0001 The optimal therapy of patients presenting with unstable angina with or without enzyme rise but without ST elevation (UA/NSTEMI) is still debatable. Several (FRISC II, TACTICS-TIMI 18, RITA 3, ISAR-COOL, TIMACS), although not all (ICTUS, ELISA, OPTIMA, ABOARD, LIPSIA-NSTEMI), randomized trials have provided evidence in favour of an invasive strategy compared to conservative medical therapy in non-ST elevation acute coronary syndromes (NSTE-ACS). ...
Eugene Braunwald: Maestro Of American Cardiology pg. 7. For five "nail-biting" years, Braunwalds team waited for the results, which ultimately showed that patients who took pravastatin to lower serum cholesterol indeed reduced their risk for having another heart attack, stroke, or dying of cardiovascular causes.. More recent TIMI trials have examined the effect of driving cholesterol levels even lower, and have found not only that "lower is better," but that "much lower is much better." TIMI investigators are currently studying the effects of reducing a patients LDL to a level in the 50s, levels undreamed of ten years ago.. "Weve followed all of these patients extremely carefully and we dont see any serious side effects with even extreme cholesterol lowering," says Braunwald. "We have not yet reached the (LDL-concentration) floor.". For more than a half century as an academic physician-scientist, Braunwald has been instrumental in numerous discoveries that have saved millions of lives, and, ...
TY - JOUR. T1 - Postinfarction unstable angina. Pathophysologic basis for current modalities. AU - Becker, R. C.. AU - Gore, J. M.. AU - Alpert, J. S.. PY - 1989/1/1. Y1 - 1989/1/1. N2 - Unstable angina is an acute coronary syndrome characterized by the rapid progression of clinical symptoms which may culminate in acute myocardial infarction, infarct extension or sudden death. The pathologic substrate involves atherosclerotic plaque rupture with platelet deposition, thrombus formation and coronary arterial spasm. Patients with postinfarction angina represent a high-risk subgroup with severe multivessel disease, compromised collateral vessels and/or partially occlusive thrombi; their risk of infarct extension and death is significantly increased. Initial therapy includes nitrates, beta-adrenergic blockers, calcium channel antagonists, aspirin and possibly i.v. heparin, as well as prompt identification and control of exacerbating factors. Thrombolytic therapy may assume a more central role based ...
ABOARD: Angioplasty to Blunt the rise Of troponin in Acute coronary syndromes Randomized for an immediate or Delayed intervention. -Immediate versus Delayed Invasive Strategies in Patients with Non-ST Elevation ACS by Dr. Gilles Montalescot. ICTUS: Invasive Versus Conservative Treatment in Unstable Coronary Syndromes. -Early invasive strategy vs conservative, selective invasive strategy in troponin positive patients with non-STEMI ACS by Dr. Robbert J. De Winter. MATE: Medicine versus angiography in thrombolytic exclusion. -Triage angiography in suspected acute MI patients considered ineligible for reperfusion therapy by Dr. Peter A. McCullough. NRMI: National Registry of Myocardial Infarction. -Outcomes Among NSTEMI Patients Presenting to Hospitals With and Without Backup Cardiac Surgery by Dr. Yuri B. Pride. TACTICS TIMI 18: Treat Angina with Aggrastat + Determine Cost of Therapy with an Invasive or Conservative Strategy. -Treat Angina with Aggrastat + Determine Cost of Therapy with an ...
This is the first UK study to show that patients admitted to DGHs with unstable angina or NSTEMI and who are stratified at high risk wait significantly longer for angiography and revascularisation than similar patients admitted to a hospital containing a tertiary centre for cardiac services. Specifically, DGH patients were found to wait over two and a half times longer for angiography and over twice as long for revascularisation. The study hypothesis has therefore been proved.. The baseline characteristics of the MRI and DGH groups of patients were well matched except that more MRI than DGH patients had previously undergone coronary revascularisation. This is probably due to the fact that patients who have had a coronary procedure tend to represent to the hospital where they had it done and often remain under regular follow up at the tertiary centre. It is not clear why significantly more DGH patients had raised cholesterol.. If the "hit list" for invasive assessment and treatment of patients ...
An increased tissue endothelin-1 (ET-1) immunoreactivity has been demonstrated at the site of the culprit lesion (CL) in patients with unstable angina (UA) thus suggesting that ET-1 may be involved in the abnormal vasoreactivity of the CL in UA. The aim of this study was to establish whether an enhanced local release of ET-1 is involved in the pathogenesis of the enhanced vasoreactivity of the unstable plaque in patients with UA. We studied 9 patients with UA and 9 patients with stable angina (SA) with a single proximal lesion of the left anterior descending coronary artery. Luminal diameter of the CL and of the proximal, middle and distal normal-appearing coronary segments were measured by quantitative coronary angiography at baseline, during cold pressor test (CPT) and after intracoronary administration of nitroglycerine (NTG). ET-1 levels were measured in blood samples obtained proximally and distally to the coronary CL before and after successful stent implantation. During CPT, the CL in ...
Another name for Unstable Angina is Angina. The long-term treatment of angina depends on the severity of the coronary artery disease, the condition of ...
Among elderly patients with NSTE-ACS, invasive therapy was beneficial at reducing adverse cardiovascular events compared with conservative therapy. This was due to a reduction in recurrent MI and urgent revascularization procedures. There was suggestion of harm for patients ,90 years of age; however, definitive conclusions in this group were not possible due to the limited number of patients. This trial is unique in that no crossovers occurred between the treatment groups, unlike previous trials in which a large proportion of conservative patients underwent angiography. Elderly patients are at high risk for adverse events after a NSTE-ACS, and invasive therapy remains the optimal treatment to reduce this risk.. ...
The Thrombolysis In Myocardial Infarction, or TIMI Study Group is an Academic Research Organization (ARO) affiliated with Brigham and Womens Hospital and Harvard Medical School. The group has its headquarters in Boston, Massachusetts, and a satellite location in Quincy. The TIMI Study Group was founded by Eugene Braunwald, MD in 1984. Dr. Braunwald held the chairmanship until 2010, when he appointed Marc Sabatine, MD to the position. The group has conducted numerous practice-changing clinical trials in patients with cardiovascular disease or risk factors for cardiovascular disease. Among the groups most important contributions to medicine is the TIMI Risk Score, which assess the risk of death and ischemic events in patients experiencing unstable angina (UA) or a non-ST elevation myocardial infarction (NSTEMI). In patients with UA/NSTEMI, the TIMI risk score is a simple prognostication scheme that categorizes a patients risk of death and ischemic events and provides a basis for therapeutic ...
New life-saving treatments for Angina in clinical trial on Seeking Oklahomans who have been diagnosed with chronic or unstable angina.
Diabetes mellitus is an etiologically and clinically heterogeneous group of metabolic disorders that share the commonality of hyperglycemia. Long-term hyperglycemia produces tissue damage, which ultimately manifests as microvascular and macrovascular disease, and neuropathy. The presence of macrovascular disease should alert clinicians to the possibility that the patient may have coronary artery disease, particularly because coronary artery disease and myocardial ischemia are likely to be silent. Elderly patients with diabetes mellitus are also more likely to develop congestive heart failure. Patients with unstable coronary syndromes, decompensated heart failure, and symptomatic cardiac arrhythmias are at increased risk of perioperative cardiovascular complications (myocardial infarction, heart failure, and sudden death) while undergoing noncardiac procedures. In addition, clinicians must avoid the risk of hypoglycemic episodes. Oral health care providers can expect to be called upon to care for ...
Chest pain is a nonspecific symptom that can have cardiac or noncardiac causes (see DDx). Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which range from ST-segment elevation myocardial infarction (STEMI) to non-STEMI (NSTEMI).
Chest pain is a nonspecific symptom that can have cardiac or noncardiac causes (see DDx). Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which range from ST-segment elevation myocardial infarction (STEMI) to non-STEMI (NSTEMI).
The study included adult patients with established or known CAD, which was defined as having a diagnosis of at least one of the following on their medical problem list: Coronary artery disease, chronic angina, or atherosclerosis of the aorta. Exclusion criteria were unstable angina or acute coronary syndrome, both ST and non-ST segment elevation myocardial infarctions within 60 days before the start of the program; current pregnancy; life expectancy less than 1 year such as in patients with terminal cancer or those under hospice care; current chemotherapy; advanced or end-stage organ disease; active alcohol or drug abuse problems; inability to tolerate a high-fiber diet secondary to active inflammatory bowel disease; inability to understand spoken English because the program includes videos that are available only in English; and previous participation in CHIP or the health education classes.. All patients were randomly assigned to either the CHIP group or HH group. In both groups, sessions ...
This guideline covers treatments for people aged 18 and over with unstable angina (recurring chest pain) or a type of heart attack called non-ST-segment-elevation myocardial infarction (NSTEMI). It aims to ensure that people get treatment quickly.
Unstable angina or sometimes referred to as acute coronary syndrome causes unexpected chest pain, and usually occurs while resting. The most common cause is reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildups (atherosclerosis) which can rupture causing injury to the coronary blood vessel resulting in blood clotting which blocks the flow of blood to the heart muscle ...
Covers causes of heart attack (myocardial infarction) and unstable angina. Discusses symptoms like chest pain or pressure. Explains MI and angina differences. Offers prevention tips. Covers diagnostic tests and treatment with medicines and surgery.
Covers causes of heart attack (myocardial infarction) and unstable angina. Discusses symptoms like chest pain or pressure. Explains MI and angina differences. Offers prevention tips. Covers diagnostic tests and treatment with medicines and surgery.
Covers causes of heart attack (myocardial infarction) and unstable angina. Discusses symptoms like chest pain or pressure. Explains MI and angina differences. Offers prevention tips. Covers diagnostic tests and treatment with medicines and surgery.
The choice of an "invasive" or "conservative" strategy for the initial management of patients with acute coronary syndromes (ACSs) has been evaluated in 7 RCTs, the results of which have been summarized by 2 groups using meta-analysis. Although it seems that the 2 meta-analyses reached different conclusions, both groups supported the invasive strategy in their respective discussion sections. Several trial limitations have confused the debate on what used to be a contentious subject, but the evidence now favors percutaneous coronary intervention (PCI) for NSTEMI. First, the terms that describe the strategies need to be clarified. The "invasive strategy" refers to the routine use of cardiac catheterization, not coronary revascularization with PCI or coronary artery bypass graft (CABG) surgery. The "conservative strategy" limits the use of cardiac catheterization to patients with spontaneous or provokable ischemia, but the term does not convey the fact that 50% of patients allocated to this ...
Unstable angina is a potentially dangerous condition, and management should be tailored to prevent adverse outcomes. Patients should be admitted to the cardiac care unit, placed at bedrest, and begun on antianginal therapy with either P-blockers or calcium channel blockers, aspirin, and intravenous nitrates. (J-Blockers, when added to nitrates, have been shown to reduce symptoms […] Read more. ...
Unstable Angina and NSTEMIs: Management Principles. Meira Louis Lisa Campfens. Outline. Pick your/ cardios strategy Initial therapy...for everyone? Pick an anti-platelet...or two...or three... Protect the stomach??? PPI controversy Pick the right anti-coagulant Slideshow 2224058...
Among patients with NSTEMI/UA, treatment with clopidogrel in addition to standard therapy was associated with a reduction in death, MI, or stroke at 30 days and from 31 days to 1 year. For the primary endpoint plus refractory or severe ischemia, benefit was seen by the first 24 hours. However, for the primary endpoint alone, benefit was not observed until after day 7. This substudy did not address how PCI use affected these outcomes and the timing of the events. Finally, approximately 21% of patients in CURE underwent PCI, a much lower rate of PCI than what is typically used in the US in NSTEMI/UA patients. It is therefore unclear how applicable the data would be in a population treated more aggressively with PCI.. ...
Find out all information about angina at rest also known as unstable angina. This condition is marked by chest pain which appears while person is at rest
Angina is chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesnt get as much blood as it needs. This usually happens because one or more of the hearts arteries is narrowed or blocked, also called ischemia. Stable angina refers to "predictable" chest discomfort associated with exertion or stress. Unstable angina refers to unexpected chest pain and usually occurs at rest. It is typically more severe and prolonged. Unstable angina should be treated as an emergency.. ...
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My chest pains started up again about 2 months ago after 9 months without. I had one really bad attack, but then went for 10 days with hardly any. Thursday and Friday I had prolonged low-grade chest ...
To the best of our knowledge, there have been no studies investigating the association among diabetes, angiogenic factors, and oxidative stress in human heart tissue affected by ischemic insult. The main findings of our study demonstrate an association between diabetes, reduced expression of HIF-1α and VEGF, and increment of iNOS, O2−, and nitrotyrosine levels in heart specimens of patients with unstable angina. Diabetes amplifies oxidative reaction and worsens the angiogenic process. In nondiabetic patients, we detected increased steady-state levels of HIF-1α and VEGF after unstable angina. This accumulation of both mRNA and protein was limited to the region of affected myocardium. No HIF-1α and VEGF transcripts or proteins were detectable in nonischemic specimens. In diabetic patients, the picture is quite different because both HIF-1α and VEGF levels were significantly lower than those in nondiabetic heart specimens. Thus, the roles of HIF-1α and VEGF in beginning angiogenic process ...
Sigma-Aldrich offers abstracts and full-text articles by [Ke-Fei Dou, Bo-Qia Xie, Xiao-Jin Gao, Yan Li, Yue-Jin Yang, Zuo-Xiang He, Min-Fu Yang].
2006 (Swedish)In: Läkartidningen, ISSN 0023-7205, Vol. 103, no 30-31, 2240-1; discussion 2241 p.Article in journal (Refereed) Published ...
Fibrin, Plasma, 1,4-butanediamine, Homocysteine, Plasminogen, Cardiac Death, Concentration, Death, Infarction, Myocardial Infarction, Stroke, Unstable Angina, Adp, ATP, Collagen, Estradiol, Estrogenic Effects, Hand, Methods, Orientation
Plavix is used for reducing the risk of stroke or heart attack in patients who have already had a heart attack or stroke, have other circulatory problems caused by narrowing and hardening of the arteries, or have certain other heart problems (eg, unstable angina ...
BACKGROUND: The Thrombolysis In Myocardial Infarction (TIMI) Risk Score has been shown to predict prognosis in acute coronary syndromes (ACS) comprised of unstable angina (UA) and non-ST segment elevation myocardial infarction (STEMI). We sought to evaluate the impact of newer antiplatelet and antithrombotic therapies for ACS, such as glycoprotein IIb/IIIa inhibitors (GPI) and low molecular weight heparin (LMWH), on in-hospital outcomes over time in patients (pts) with similar TIMI risk scores.. METHODS: The baseline demographics and clinical outcomes of pts with ACS (UA and non-STEMI) in 1998 (Group 1998) and 2000 (Group 2000) at a single large university medical center were compared using a prospectively collected database. In-hospital major adverse cardiac events (MACE) included death, MI, or recurrent angina that resulted in urgent revascularization. Risk was estimated by utilizing the TIMI Risk Score, which uses 7 predictor variables: age , 65 years, at least 3 risk factors for coronary ...
References: Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.. Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 50.. Sabatine MS, Cannon CP. Approach to the patient with chest pain. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwalds Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 53.. Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline). ...
Objectives: This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. Background The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate.. Methods: Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk ...
This study demonstrates that UA/NSTEMI patients who would have been excluded from the randomized enoxaparin trials can be safely treated with a weight-adjusted regimen of subcutaneous enoxaparin, as long as particular attention is paid to age and renal function to further adjust the dosing regimen. The EP population represents a high-risk group of patients who had a fourfold increase in death or MI at 30 days. Hypertension and the use of GP IIb/IIIa inhibitors were the only predictors of bleeding found in our study population.. There is strong evidence that antithrombin therapy is beneficial in UA/NSTEMI patients and that subcutaneous enoxaparin is superior to UH in this setting (1-3). However, this demonstration has been obtained in selected populations, and it is not known whether these results can be applied to all comers who present with UA/NSTEMI, including those who would have been excluded from these randomized trials. Furthermore, the safety of enoxaparin in a population at a high risk ...
Background: In patients with acute non-ST elevation myocardial infarction (NSTEMI) coronary arteriography is usually recommended however visual interpretation of the coronary angiogram is subjective. A complementary diagnostic approach involves measuring the pressure drop across a coronary stenosis (fractional flow reserve, FFR) with a pressure-sensitive guidewire.. Hypothesis: Routine FFR measurement is feasible in NSTEMI patients and has additive diagnostic, clinical and health economic utility, as compared to angiography-guided standard care.. Design: A prospective multi-center randomized controlled trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% severity (threshold for FFR measurement). Patients will be randomized immediately after coronary angiography to the FFR-guided group or angiography-guided group (FFR measured, not disclosed). All patients will then undergo FFR measurement in all vessels with a coronary stenosis ≥30% severity. FFR will be measured in culprit and ...
The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC /AHA Guidelines (CRUSADE) Quality Improvement Initiative.
Most patients with a non-ST elevation acute coronary syndrome (unstable angina and non-ST elevation myocardial infarction) undergo coronary angiography and revascularization during the index hospitalization. This topic will summarize the evidence sup
Our finding that mean platelet component is lower in acute myocardial infarction than in unstable angina, reflecting greater platelet activation, confirms the central role of thrombogenicity in the pathogenesis of acute coronary syndromes. Indeed, platelet activation was an independent predictor of the mode of presentation and, even in the subgroup of patients with unstable angina at high risk of future events, platelet activation was significantly lower than in those with myocardial infarction.. Some studies have not found a difference in platelet activation between unstable angina and myocardial infarction. However, Garlichs and colleagues2 found greater expression of the CD40 ligand in unstable angina than in myocardial infarction. This appears counterintuitive but may reflect greater hydrolysis and release of the ligand in myocardial infarction. Mathur and colleagues3 found a greater expression of P selectin in myocardial infarction than in unstable angina but also found that mean platelet ...
TY - JOUR. T1 - Issues in antithrombin therapy for UA/NSTEMI. AU - Alpert, Joseph S.. AU - Budaj, A. J.. AU - Gurfinkel, E. P.. AU - Henry, T. D.. PY - 2001/8/27. Y1 - 2001/8/27. N2 - In September 2000, participants at the 4th Annual Experts Meeting of the International Cardiology Forum convened to discuss guidelines for the management of unstable angina/non-ST-elevation MI, recently published by North American and European task forces. Discussion of new recommendations for antithrombin therapy focused on the role of low-molecular-weight heparin (LMWH). Although most participants found the new guidelines largely consistent with existing data, and sufficiently adaptable to most clinical settings, there was concern that neither task force specified LMWH as the antithrombin of choice for the medical management of these patients. The new guidelines continue to endorse the use of unfractionated heparin, particularly for high-risk patients, despite the evidence for the efficacy of LMWH in this ...
Objective: To analyse intensity of treatment of high-risk patients with non-ST elevation acute coronary syndromes (NSTEACS) included in the DESCARTES (Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español) registry.. Patients and setting: Patients with NSTEACS (n = 1877) admitted to 45 randomly selected Spanish hospitals in April and May 2002 were studied.. Design: Patients with ST segment depression and troponin rise were considered high risk (n = 478) and were compared with non-high risk patients (n = 1399).. Results: 46.9% of high-risk patients versus 39.5% of non-high-risk patients underwent angiography (p = 0.005), 23.2% versus 18.8% (p = 0.038) underwent percutaneous revascularisation, and 24.9% versus 7.4% (p , 0.001) were given glycoprotein IIb/IIIa inhibitor. In-hospital and six-month mortality were 7.5% versus 1.1% and 17% versus 4.6% (p , 0.001), respectively. A treatment score (⩾ 4, 2-3 and , 2) was defined according to the number of class I ...
During the past few decades two treatment strategies have evolved for patients with unstable coronary artery disease (UCAD). The non-invasive strategy uses clinical investigations and non-invasive stress tests to identify patients who need diagnostic catheterisation. The early invasive strategy uses coronary catheterisation as the diagnostic instrument. The new technologies have consequences not only for the clinical endpoints of death or myocardial infarction (MI), but also in terms of health-related quality of life and costs. The economic evaluations are of great importance due to the high incidence of the disease and high short-term costs of the invasive strategy. The early costly intervention may prevent later complications and thereby partly or completely offset the higher initial treatment costs. Even if longterm costs remain higher, they can be justified by improved survival or quality of life. Such clinical effects in the long-term follow-up need to be seen in relation to the cost of the ...
A 55-year-old woman developed unstable angina following an episode of severe anaphylaxis which was treated with 0.5 mg intramuscular epinephrine (adrenaline). The exact cause of her ongoing unstable angina was uncertain but may have reflected either