Unstable angina / non ST elevation myocardial infarction angiogram
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Coronary Angiography in Unstable angina / NSTEMI
One other image modality that can be used in diagnosing and treating UA / NSTEMI is CT coronary angiography. This is a superior imaging technique with a sensitivity and specificity of 90% and 95% respectively [1][2]. If there is no evidence of either calcified or noncalcified plaque on coronary angiogram, then it is highly unlikely that the patient’s symptoms are due to UA/NSTEMI.
Indications
CT coronary angiography may be appropriate in:
- evaluation of obstructive coronary artery disease in symptomatic patients (class IIa).
- patients with acute chest pain with intermediate and possibly low pretest probability of CAD when serial ECG and cardiac biomarkers are negative [3].
Timing
Some believe that by performing angiography immediately on arrival of ACS patient is an efficient approach. In patients in whom lesion is not found may be discharged rapidly or shifted to a different management strategy. Patients in whom there is obvious culprit lesions can undergo PCI immediately and thereby reducing hospital stay or can be sent expeditiously to undergo CABG and thereby avoiding risky waiting period.
An early invasive strategy including coronary angiography may be required if aggressive medical therapy fails to stabilize the patient, if prior revascularization procedures have been performed, in the presence of recurrent angina, and in the presence of abnormal non-invasive test results.
References
- ↑ Fine JJ, Hopkins CB, Ruff N, Newton FC (2006). "Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease". The American Journal of Cardiology. 97 (2): 173–4. doi:10.1016/j.amjcard.2005.08.021. PMID 16442357. Retrieved 2011-04-08. Unknown parameter
|month=ignored (help) - ↑ Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005). "Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography". Journal of the American College of Cardiology. 46 (3): 552–7. doi:10.1016/j.jacc.2005.05.056. PMID 16053973. Retrieved 2011-04-08. Unknown parameter
|month=ignored (help) - ↑ Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR (2006). "ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology". Journal of the American College of Cardiology. 48 (7): 1475–97. doi:10.1016/j.jacc.2006.07.003. PMID 17010819. Retrieved 2011-04-08. Unknown parameter
|month=ignored (help)