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New Approaches to Diagnosis and Management of Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
Robert A. O'Rourke, MD;
Judith S. Hochman, MD;
Marc C. Cohen, MD;
Charles L. Lucore, MD;
Jeffrey J. Popma, MD;
Christopher P. Cannon, MD
Arch Intern Med. 2001;161:674-682.
Recently, it has been demonstrated in multiple clinical research studies
that non–Q-wave myocardial infarction shares many of the features of
unstable angina pectoris and that both diseases initially are managed similarly.
Important new antiplatelet drugs (glycoprotein IIb-IIIa inhibitors) and antithrombin
agents (low-molecular-weight heparin) are currently recommended for patients
with unstable angina pectoris/non–ST-segment elevation MI who are at
high or intermediate risk on the basis of symptoms, electrocardiographic findings,
and the presence or absence of serum markers (eg, troponin I, troponin T,
and creatine kinase-MB). This review provides important information concerning
the results of clinical studies of glycoprotein IIb-IIIa inhibitors (tirofiban
hydrochloride and eptifibatide) when used with unfractionated heparin in patients
with this syndrome or with low-molecular weight heparin (enoxaparin sodium)
in similar patients. The Thrombolysis in Myocardial Infarction IIIB, Veterans
Affairs Non–Q-Wave Infarction Studies in Hospital, and Fast Revascularization
During Instability in Coronary Artery Disease II studies evaluating a conservative,
ischemia-guided approach vs an early aggressive approach to such patients
are presented, with a practical algorithm for treating such patients.
From the Divisions of Cardiology, Department of Medicine, University
of Texas Health Science Center at San Antonio (Dr O'Rourke), Roosevelt Hospital,
New York, NY (Dr Hochman), Hahnemann University Hospital, Philadelphia, Pa
(Dr Cohen), and Brigham and Women's Hospital, Boston, Mass (Drs Popma and
Cannon); and Prairie Cardiovascular Consultants, Ltd, Springfield, Ill (Dr
Lucore). Dr O'Rourke has received research grants from Merck & Co, Inc,
Pfizer & Co, Inc, DuPont Pharmaceuticals Company and Fujisawa Healthcare,
Inc, and Aventis Pharmaceutical Company; Dr Hochman has received research
grants from Merck & Co, Inc, Cor Therapeutics, Centocor, Inc, and Rhone-Poulenc
Pharmaceutical Company; Dr Cohen has received grant and research support from
Rhone-Poulenc Pharmaceutical Company; Dr Lucore has served as a consultant
and participated on the speaker's bureau for Merck & Co, Inc, Eli Lilly
and Company, Centocor, Inc, and Genentech, Inc, for continuing medical education
programs and database studies in his institution; and Dr Cannon currently
receives research grant support through the Department of Medicine of Brigham
and Women's Hospital from Dade Behring, Merck & Co, Inc, Aventis Pharmaceutical
Company, Bristol-Myers Squibb, and COR Therapeutics, Inc; is on the speaker
bureau for Aventis Pharmaceutical Company, Bristol-Myers Squibb, Centocor,
Inc, COR Therapeutics, Inc, Eli Lilly and Company, Merck & Co, Inc, and
Sanofi, Inc; and has received honoraria for preparation of educational materials
from Centocor, Inc, Eli Lilly and Company, Excerpta Medica, Ingenix, Inc,
and Merck & Co, Inc.
RELATED LETTER
New Approaches to Diagnosis and Management of Unstable Angina and Non–ST Segment Elevation Myocardial Infarction: Controversial Data
J. Borja, M. A. Paz, P. Olivella, and Robert A. O'Rourke
Arch Intern Med. 2002;162(4):485-486.
EXTRACT
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ABSTRACT
| FULL TEXT
New Approaches to Diagnosis and Management of Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Controversial Data
Borja et al.
Arch Intern Med 2002;162:485-486.
FULL TEXT
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