Unstable angina non ST elevation myocardial infarction classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Braunwald in 1989 proposed a classification for unstable angina based on severity and clinical circumstances. This classification was employed in various clinical trials and studies to determine its prognostic importance and clinical usefulness. In recent years with the more detailed understanding of the pathophysiology of unstable angina and the discovery of improved markers of myocardial injury, acute phase proteins and hemostatic markers, especially cardiac troponin I and troponin T it was suggested to extend Class IIIB (angina at rest within the past 48 hrs) of the original classification, by subclassifying it into troponin negative and troponin positive patients.

Classification

Braunwald clinical classification of unstable angina[1]

Severity Clinical Circumstances
A (Secondary Angina) B (Primary Angina) C (Postinfarction Angina)
Class I - New onset of severe angina or accelerated angina; no rest pain IA IB IC
Class II - Angina at rest within past month but not within preceding 48hours (angina at rest, subacute) IIA IIB IIC
Class III - Angina at rest within 48hours (angina at rest, subacute) IIIA IIIB-TPos IIIB-TNeg IIIC
  • Secondary Angina = Unstable angina secondary to a clearly identified condition extrinsic to the coronary vascular bed that has intensified myocardial ischemia
  • Primary Angina = Uunstable angina pectoris in the absence of an extracardiac condition that has intensified ischemia
  • Postinfarction Angina = Unstable angina within the first 2 weeks after a documented acute myocardial infarction

Various studies have shown a correlation between the clinical classes and coronary anatomy. Servi et al reported that Class IB patients (new onset or worsening angina without resting pain) had clacified lesions more frequently than did patients with Classes IIB and IIIB. On the other hand Classes IIB and IIIB were associated with thrombus and intraplaque hemorrhage on angiography. Similarly histological features like high cellularity, thrombus and abundant neovessels are associated with higher classes of unstable angina.

References

  1. Hamm CW, Braunwald E (2000). "A classification of unstable angina revisited". Circulation. 102 (1): 118–22. PMID 10880424. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)


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