PMID- 14551514
OWN - NLM
STAT- MEDLINE
DCOM- 20040621
LR  - 20071114
IS  - 0026-4725 (Print)
IS  - 0026-4725 (Linking)
VI  - 51
IP  - 5
DP  - 2003 Oct
TI  - The management of unstable angina and non-ST-segment elevation myocardial 
      infartion.
PG  - 433-45
AB  - Patients presenting with unstable angina and non-ST elevation myocardial 
      infarction (UA/NSTEM) have a highly variable course. Optimal management is 
      critical because of the high risk of death or myocardial infarction (MI) in the 
      ensuing 30 days. In this article, we review the therapeutic options available to 
      clinicians. Anti-ischemic therapy with beta-blockers and nitrates should be 
      considered in all patients without contraindications. Aspirin remains a 
      cornerstone of antiplatelet therapy and has been shown to substantially reduce 
      the risk of death or MI. Although the data are less robust, unfractionated 
      heparin (UFH) also appears to be efficacious, and the low-molecular-weight 
      heparin (LMWH) enoxaparin appears to be superior to UFH. The GP IIb/IIIa 
      inhibitors, highly beneficial in the setting of percutaneous coronary 
      intervention (PCI), should be considered in patients with continuing ischemia or 
      other high-risk features. The ADP receptor blocker clopidogrel has been shown to 
      be beneficial in patients who are managed conservatively and in those who undergo 
      PCI. Lastly, a strategy of early angiography should be considered in patients 
      with recurrent ischemia or in those who present with high-risk features such as 
      elevated troponins or ST deviation. Thus, early risk stratification using 
      clinical features, electrocardiographic data, and biomarkers allows 
      identification of subgroups of patients who are not only at high risk but also 
      enjoy the greatest benefits from these aggressive therapies and thereby enables 
      clinicians to target these interventions most effectively.
FAU - Chen, A A
AU  - Chen AA
AD  - Cardiology Division, Massachusetts General Hospital, Boston, MA 02115, USA. 
      msabatine@partners.org
FAU - Sabatine, M S
AU  - Sabatine MS
LA  - eng
GR  - HL072872-01/HL/NHLBI NIH HHS/United States
GR  - HL072879-01/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PT  - Review
PL  - Italy
TA  - Minerva Cardioangiol
JT  - Minerva cardioangiologica
JID - 0400725
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Angina, Unstable/*therapy
MH  - Fibrinolytic Agents/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/physiopathology/*therapy
MH  - Myocardial Ischemia/drug therapy
MH  - Risk Assessment
MH  - Time Factors
RF  - 79
EDAT- 2003/10/11 05:00
MHDA- 2004/06/24 05:00
CRDT- 2003/10/11 05:00
PHST- 2003/10/11 05:00 [pubmed]
PHST- 2004/06/24 05:00 [medline]
PHST- 2003/10/11 05:00 [entrez]
PST - ppublish
SO  - Minerva Cardioangiol. 2003 Oct;51(5):433-45.