PMID- 19069375
OWN - NLM
STAT- MEDLINE
DCOM- 20090305
LR  - 20081215
IS  - 0738-0658 (Print)
IS  - 0738-0658 (Linking)
VI  - 27
IP  - 4
DP  - 2008 Dec
TI  - Unstable angina and non ST elevation acute coronary syndromes.
PG  - 395-401
AB  - Acute coronary syndromes (ACSs) are the most common cause of hospital admission 
      in patients with coronary artery disease (CAD). The term ACS refers to a spectrum 
      of acute life-threatening disorders that includes: unstable angina (UA), non ST 
      elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction 
      (STEMI). The pathophysiology is similar: coronary atherosclerosis plaque rupture 
      and subsequent thrombus formation. Such plaques usually are lesions with <50% 
      stenosis severity prior to ACS, but are lipid-rich soft plaques (vulnerable 
      plaques). The clinical presentation depends on the degree of partial (UA/NSTEMI) 
      or complete lumen obstruction of the culprit coronary artery (STEMI). This 
      article reviews the UA/NSTEMI ACS, since these two entities are closely related 
      and usually, it is not possible to distinguish them upon presentation at the 
      emergency department (ED). It presents the latest advancement on the 
      pathophysiology, clinical presentations, diagnosis, risk stratification and 
      management. It emphasizes on the selection of the optimal management approach 
      which includes early invasive versus initial conservative strategies. Besides, it 
      discusses the different approaches being used in the light of the information 
      provided by the latest clinical trials. Although, at the present time, the 
      optimal management approach remains unsettled, ACSs are usually managed using an 
      early invasive strategy in tertiary care hospitals in the USA. The application of 
      clinical practice guidelines developed by the American College of Cardiology and 
      the American Heart Association (ACC/AHA) has confirmed definite improvement of 
      patient care. Part of the information presented in this article, particularly in 
      its management, is based on these guidelines (3). Evidence base scientific data 
      insists upon using aggressive medical therapy (statins, anti-platelets, beta 
      blockers [BBs], angiotensin converting enzyme inhibitors [ACE-Is], and control of 
      coronary risk factors) as well as mechanical reperfusion, whether by percutaneous 
      coronary intervention (PCI) or by coronary artery bypass graft (CABG). These 
      approaches are considered complementary rather than as opposing strategies.
FAU - Ortega-Gil, Jorge
AU  - Ortega-Gil J
AD  - Section of Cardiology Department of Medicine of the UPR School of Medicine.
FAU - Perez-Cardona, Jose M
AU  - Perez-Cardona JM
LA  - eng
PT  - Journal Article
PL  - Puerto Rico
TA  - P R Health Sci J
JT  - Puerto Rico health sciences journal
JID - 8303541
SB  - IM
MH  - *Acute Coronary Syndrome/diagnosis/therapy
MH  - *Angina, Unstable/diagnosis/therapy
MH  - Humans
EDAT- 2008/12/17 09:00
MHDA- 2009/03/06 09:00
CRDT- 2008/12/17 09:00
PHST- 2008/12/17 09:00 [entrez]
PHST- 2008/12/17 09:00 [pubmed]
PHST- 2009/03/06 09:00 [medline]
PST - ppublish
SO  - P R Health Sci J. 2008 Dec;27(4):395-401.