New approaches to diagnosis and management of unstable angina and non-ST-segment elevation myocardial infarction

Arch Intern Med. 2001 Mar 12;161(5):674-82. doi: 10.1001/archinte.161.5.674.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Angina, Unstable / diagnosis
  • Angina, Unstable / drug therapy*
  • Angina, Unstable / therapy
  • Antithrombins / therapeutic use*
  • Biomarkers / blood
  • Diagnosis, Differential
  • Electrocardiography
  • Eptifibatide
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / therapy
  • Peptides / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Risk Factors
  • Tirofiban
  • Tyrosine / analogs & derivatives*
  • Tyrosine / therapeutic use

Substances

  • Antithrombins
  • Biomarkers
  • Heparin, Low-Molecular-Weight
  • Peptides
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Tyrosine
  • Tirofiban
  • Eptifibatide