Unstable angina non ST elevation myocardial infarction classification: Difference between revisions

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{{Unstable angina / NSTEMI}}
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{{CMG}} {{AE}} {{RT}}
{{CMG}} {{AE}} {{RT}}


==Overview==
==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.
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 trial|clinical trials]] and [[Clinical study|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 [[Cardiac markers|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 [[Patient|patients]].


==Classification==
==Classification==
===Braunwald clinical classification of unstable angina<ref name="pmid10880424">{{cite journal |author=Hamm CW, Braunwald E |title=A classification of unstable angina revisited |journal=[[Circulation]] |volume=102 |issue=1 |pages=118–22 |year=2000 |month=July |pmid=10880424 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10880424 |accessdate=2011-04-08}}</ref>===
 
===Braunwald Clinical Classification of Unstable Angina<ref name="pmid10880424">{{cite journal |author=Hamm CW, Braunwald E |title=A classification of unstable angina revisited |journal=[[Circulation]] |volume=102 |issue=1 |pages=118–22 |year=2000 |month=July |pmid=10880424 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10880424 |accessdate=2011-04-08}}</ref>===
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<br>'''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]].


* Secondary Angina = Unstable angina secondary to a clearly identified condition extrinsic to the coronary vascular bed that has intensified [[myocardial ischemia]]
=== Correlation of Coronary Anatomy and Classification ===
* 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<ref name="pmid9269135">{{cite journal |author=Owa M, Origasa H, Saito M |title=Predictive validity of the Braunwald classification of unstable angina for angiographic findings, short-term prognoses, and treatment selection |journal=Angiology |volume=48 |issue=8 |pages=663–71 |year=1997 |month=August |pmid=9269135 |doi= |url=}}</ref><ref name="pmid9753852">{{cite journal |author=Calton R, Satija T, Dhanoa J, Jaison TM, David T |title=Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus |journal=Indian Heart J |volume=50 |issue=3 |pages=300–6 |year=1998 |pmid=9753852 |doi= |url=}}</ref>. 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 [[coronary angiography]].  Similarly the study showed an association of histological features like high cellularity, [[thrombus]] and abundant neovessels with higher classes of unstable angina.
* Various studies have shown a correlation between the clinical classes and coronary anatomy.<ref name="pmid9269135">{{cite journal |author=Owa M, Origasa H, Saito M |title=Predictive validity of the Braunwald classification of unstable angina for angiographic findings, short-term prognoses, and treatment selection |journal=Angiology |volume=48 |issue=8 |pages=663–71 |year=1997 |month=August |pmid=9269135 |doi= |url=}}</ref><ref name="pmid9753852">{{cite journal |author=Calton R, Satija T, Dhanoa J, Jaison TM, David T |title=Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus |journal=Indian Heart J |volume=50 |issue=3 |pages=300–6 |year=1998 |pmid=9753852 |doi= |url=}}</ref>   
* Servi et al. reported that Class IB [[patients]] (new onset or worsening angina without resting pain) had [[Calcified lesion|calcified lesions]] more frequently than did [[Patient|patients]] with Classes IIB and IIIB.   
* Classes IIB and IIIB were associated with [[thrombus]] and intraplaque [[Bleeding|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==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 21:04, 5 December 2022



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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

  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)
  2. 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)
  3. 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.

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