Unstable angina non ST elevation myocardial infarction coronary angiography
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to Hospitals Treating Unstable angina non ST elevation myocardial infarction coronary angiography |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [6]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
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.
Coronary Angiography Timing
Some believe that by performing angiography immediately on arrival of ACS patient is an efficient approach. 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.
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[3]
PCI in patients of Unstable Angina/NSTEMI (DO NOT EDIT)[3]
| Class I |
| "1. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in UA/NSTEMI patients who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures).[4][5][6] (Level of Evidence: B)" |
| "2. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in initially stabilized UA/NSTEMI patients (without serious comorbidities or contraindications to such procedures) who have an elevated risk for clinical events.[5][6][7][8] (Level of Evidence: A)" |
| "3. The selection of PCI or CABG as the means of revascularization in the patient with acute coronary syndrome (ACS) should generally be based on the same considerations as those without ACS.[9][6][10][11](Level of Evidence: B)" |
| Class III (No Benefit) |
| "1. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is not recommended in patients with extensive co-morbidities (e.g., liver or pulmonary failure, cancer) in whom: |
| a. The risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization, (Level of Evidence: C) |
| b. There is a low likelihood of ACS despite acute chest pain, or (Level of Evidence: C) |
| c. Consent to revascularization will not be granted regardless of the findings. (Level of Evidence: C)" |
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) - ↑ 3.0 3.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter
|month=ignored (help) - ↑ Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT (2006)Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48 (7):1319-25. [1] PMID: 17010789
- ↑ 5.0 5.1 Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N et al. (2001)Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 344 (25):1879-87.DOI:10.1056/NEJM200106213442501 PMID:[2]
- ↑ 6.0 6.1 6.2 Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG et al. (2010)Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol 55 (22):2435-45.DOI:10.1016/j.jacc.2010.03.007PMID:20359842
- ↑ (1999)Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators.Lancet 354 (9180):708-15. PMID: 10475181
- ↑ Mehta SR, Granger CB, Boden WE, Steg PG, Bassand JP, Faxon DP et al. (2009)versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360 (21):2165-75.DOI:10.1056/NEJMoa0807986 PMID:19458363
- ↑ Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL et al. (1996) Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease.J Thorac Cardiovasc Surg 111 (5):1013-25. PMID: [3]
- ↑ Rodriguez AE, Baldi J, Fernández Pereira C, Navia J, Rodriguez Alemparte M, Delacasa A et al. (2005)follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol 46 (4):582-8.[4] PMID:16098419
- ↑ Valgimigli M, Dawkins K, Macaya C, de Bruyne B, Teiger E, Fajadet J et al. (2007)Impact of stable versus unstable coronary artery disease on 1-year outcome in elective patients undergoing multivessel revascularization with sirolimus-eluting stents: a subanalysis of the ARTS II trial. J Am Coll Cardiol 49 (4):431-41.DOI:10.1016/j.jacc.2006.06.081 PMID:17258088
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