Unstable angina non ST elevation myocardial infarction classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Dr. Eugene Braunwald in 1989 proposed a classification system for unstable angina based on severity and clinical circumstances. This classification system was employed in various clinical trials and studies to determine its prognostic importance and clinical usefulness. In the recent years with 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: Unstable 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.
Correlation of Coronary Anatomy and Classification
- Various studies have shown a correlation between the clinical classes and coronary anatomy.[2][3]
- Servi et al. reported that Class IB patients (new onset or worsening angina without resting pain) had calcified lesions more frequently than did patients with Classes IIB and IIIB.
- Classes IIB and IIIB were associated with thrombus and intraplaque hemorrhage on coronary angiography.
- The study showed an association of histological features, such as high cellularity, thrombus, and abundant neovessels, with higher classes of unstable angina.
References
- ↑ 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) - ↑ Owa M, Origasa H, Saito M (1997). "Predictive validity of the Braunwald classification of unstable angina for angiographic findings, short-term prognoses, and treatment selection". Angiology. 48 (8): 663–71. PMID 9269135. Unknown parameter
|month=ignored (help) - ↑ Calton R, Satija T, Dhanoa J, Jaison TM, David T (1998). "Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus". Indian Heart J. 50 (3): 300–6. PMID 9753852.