New ACC/AHA Guidelines on the Management of Unstable Angina
New ACC/AHA Guidelines on the Management of Unstable Angina
The last quarter century has witnessed enormous strides in the understanding of acute coronary syndrome (ACS) pathophysiology and management. These have included the critical role of coronary thrombosis, the novel concept of a therapeutic benefit of reperfusion therapy, and finally, the demonstration of mortality reductions with fibrinolysis in large, multicenter trials.
However, these trials also uncovered the paradox that fibrinolysis did not benefit and may have even harmed individuals with non-ST-segment elevation myocardial infarction (NSTEMI) patients. This central management dichotomy, together with other differences between ST-segment elevation myocardial infarction (STEMI) and unstable angina (UA) /NSTEMI patients, has been reflected since 2000 in clinical practice guidelines. Yet, despite these differences, management of NSTEMI has more in common with STEMI than it has distinct differences. Moreover, whereas the incidence and risk of STEMI have decreased over the past 25 years, today the majority of patients with ACS present with NSTEMI; that is, they have ST-segment depression or prominent T-wave inversion and/or positive biomarkers of necrosis. In 2004, the National Center for Health Statistics reported 669,000 hospitalizations for UA and 896,000 for MI.
The last quarter century has witnessed enormous strides in the understanding of acute coronary syndrome (ACS) pathophysiology and management. These have included the critical role of coronary thrombosis, the novel concept of a therapeutic benefit of reperfusion therapy, and finally, the demonstration of mortality reductions with fibrinolysis in large, multicenter trials.
However, these trials also uncovered the paradox that fibrinolysis did not benefit and may have even harmed individuals with non-ST-segment elevation myocardial infarction (NSTEMI) patients. This central management dichotomy, together with other differences between ST-segment elevation myocardial infarction (STEMI) and unstable angina (UA) /NSTEMI patients, has been reflected since 2000 in clinical practice guidelines. Yet, despite these differences, management of NSTEMI has more in common with STEMI than it has distinct differences. Moreover, whereas the incidence and risk of STEMI have decreased over the past 25 years, today the majority of patients with ACS present with NSTEMI; that is, they have ST-segment depression or prominent T-wave inversion and/or positive biomarkers of necrosis. In 2004, the National Center for Health Statistics reported 669,000 hospitalizations for UA and 896,000 for MI.
