Recent advances in the management of unstable angina and non-Q-wave myocardial infarction
| Autor: | K. S. Channer, Richard P. Steeds |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Pharmacology
medicine.medical_specialty Troponin T medicine.drug_class business.industry Unstable angina Low molecular weight heparin Electrocardiography in myocardial infarction Heparin medicine.disease Angina Internal medicine medicine Cardiology Platelet aggregation inhibitor Pharmacology (medical) cardiovascular diseases Myocardial infarction business medicine.drug |
| Zdroj: | British Journal of Clinical Pharmacology. 46:335-341 |
| ISSN: | 0306-5251 |
| Popis: | The ‘acute coronary syndromes’ represent a spectrum of disease, from Q-wave myocardial infarction to unstable angina, in which the common pathogenic feature is the rupture of an atherosclerotic plaque, followed by platelet aggregation and thrombus formation. Q-wave myocardial infarction is most strongly associated with complete arterial occlusion, whereas non-Q wave myocardial infarction and unstable angina involve lesser degrees of occlusion [1]. Immediate clinical outcomes reflect the severity of arterial occlusion, but mortality rates at 1 year are the same in those suffering Q-wave and non-Q wave myocardial infarction [2]. In addition, there is progression within 6 months to acute myocardial infarction in 45% of patients with crescendo angina, 62% of patients with acute rest angina and 25% of patients with subacute angina at rest according to the Braunwald classification based on history alone [3]. However, variations in the diagnostic criteria used for unstable angina in different studies have resulted in a range of rates of progression to acute myocardial infarction and cardiac death [4]. The most recent data would suggest that patients with non-Q wave myocardial infarction and unstable angina based on history, electrocardiogram (ECG) and cardiac enzyme activities still have a high risk of recurrent angina and cardiac death, rising from 3.3% to 14.8% between 6 and 150 days [5]. The heterogeneity of acute coronary syndromes reflects the spectrum of underlying disease but gives rise to two important points. Firstly, care must be taken in comparing data on therapeutic efficacy in trials of unstable angina because of differences in the selection criteria used for patients. Secondly, there is a clinical need to identify the patients at greatest risk amongst those who suffer from non-Q wave myocardial infarction and unstable angina, in order to target more aggressive therapies. |
| Databáze: | OpenAIRE |
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