Circulation, Vol 90, 613-622, Copyright © 1994 by American Heart Association
E Braunwald, RH Jones, DB Mark, J Brown, L Brown, MD Cheitlin, CA Concannon, M Cowan, C Edwards and V Fuster
This Quick Reference Guide for Clinicians contains recommendations on the
care of patients with unstable angina based on a combination of evidence
obtained through extensive literature reviews and consensus among members
of an expert panel. Principal conclusions include the following. (1) Many
patients suspected of having unstable angina can be discharged home after
adequate initial evaluation. (2) Further outpatient evaluation may be
scheduled for up to 72 hours after initial presentation for patients with
clinical symptoms of unstable angina judged at initial evaluation to be at
low risk for complications. (3) Patients with acute ischemic heart disease
judged to be at intermediate or high risk of complications should be
hospitalized for careful monitoring of their clinical course. (4)
Intravenous thrombolytic therapy should not be administered to patients
without evidence of ST segment elevation and acute myocardial infarction.
(5) Assessment of prognosis by noninvasive testing often aids selection of
appropriate therapy. (6) Coronary angiography is appropriate for patients
judged to be at high risk for cardiac complications or death based on their
clinical course or results of noninvasive testing. (7) Coronary artery
bypass surgery should be recommended for almost all patients with left main
disease and many patients with three-vessel disease, especially those with
left ventricular dysfunction. (8) The discharge care plan should include
continued monitoring of symptoms; appropriate drug therapy, including
aspirin; risk-factor modification; and counseling.
ARTICLES
Diagnosing and managing unstable angina. Agency for Health Care Policy and Research
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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W. Klein, A. Buchwald, S. E. Hillis, S. Monrad, G. Sanz, A. G. G. Turpie, J. van der Meer, E. Olaisson, S. Undeland, and K. Ludwig Comparison of Low-Molecular-Weight Heparin With Unfractionated Heparin Acutely and With Placebo for 6 Weeks in the Management of Unstable Coronary Artery Disease : Fragmin in Unstable Coronary Artery Disease Study (FRIC) Circulation, July 1, 1997; 96(1): 61 - 68. [Abstract] [Full Text]
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G. G. Neri Serneri, D. Prisco, F. Martini, A. Gori, T. Brunelli, L. Poggesi, C. Rostagno, G. F. Gensini, and R. Abbate Acute T-Cell Activation Is Detectable in Unstable Angina Circulation, April 1, 1997; 95(7): 1806 - 1812. [Abstract] [Full Text]
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J. A. Bittl, J. Strony, J. A. Brinker, W. H. Ahmed, C. R. Meckel, B. R. Chaitman, J. Maraganore, E. Deutsch, B. Adelman, and The Hirulog Angioplasty Study Investigators Treatment with Bivalirudin (Hirulog) as Compared with Heparin during Coronary Angioplasty for Unstable or Postinfarction Angina N. Engl. J. Med., September 21, 1995; 333(12): 764 - 769. [Abstract] [Full Text] [PDF]
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J. Fuchs and C. P. Cannon Hirulog in the Treatment of Unstable Angina : Results of the Thrombin Inhibition in Myocardial Ischemia (TIMI) 7 Trial Circulation, August 15, 1995; 92(4): 727 - 733. [Abstract] [Full Text]
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