Unstable angina non ST elevation myocardial infarction coronary angiography: Difference between revisions
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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 <ref name="pmid16442357">{{cite journal |author=Fine JJ, Hopkins CB, Ruff N, Newton FC |title=Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease |journal=[[The American Journal of Cardiology]] |volume=97 |issue=2 |pages=173–4 |year=2006 |month=January |pmid=16442357 |doi=10.1016/j.amjcard.2005.08.021 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)01746-7 |accessdate=2011-04-08}}</ref><ref name="pmid16053973">{{cite journal |author=Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA |title=Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography |journal=[[Journal of the American College of Cardiology]] |volume=46 |issue=3 |pages=552–7 |year=2005 |month=August |pmid=16053973 |doi=10.1016/j.jacc.2005.05.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)01314-8 |accessdate=2011-04-08}}</ref>. 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. | 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 <ref name="pmid16442357">{{cite journal |author=Fine JJ, Hopkins CB, Ruff N, Newton FC |title=Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease |journal=[[The American Journal of Cardiology]] |volume=97 |issue=2 |pages=173–4 |year=2006 |month=January |pmid=16442357 |doi=10.1016/j.amjcard.2005.08.021 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)01746-7 |accessdate=2011-04-08}}</ref><ref name="pmid16053973">{{cite journal |author=Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA |title=Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography |journal=[[Journal of the American College of Cardiology]] |volume=46 |issue=3 |pages=552–7 |year=2005 |month=August |pmid=16053973 |doi=10.1016/j.jacc.2005.05.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)01314-8 |accessdate=2011-04-08}}</ref>. 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. | ||
===PCI in patients with Unstable Angina/Non–ST-Elevation Myocardial Infarction<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=== | ===PCI in patients with Unstable Angina/Non–ST-Elevation Myocardial Infarction : Coronary angiography strategies in NSTEMI/UA <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=== | ||
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Revision as of 15:33, 9 October 2012
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; 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.
PCI in patients with Unstable Angina/Non–ST-Elevation Myocardial Infarction : Coronary angiography strategies in NSTEMI/UA [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:
|
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 [12].
Coronary angiography 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) - ↑ 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:11419424
- ↑ 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.2010.03.007 PMID: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)Early 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: 8622299
- ↑ Rodriguez AE, Baldi J, Fernández Pereira C, Navia J, Rodriguez Alemparte M, Delacasa A et al. (2005)Five-year 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.DOI:10.1016/j.jacc.2004.12.081 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
- ↑ 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)