Management of high-risk subsets in unstable angina.
This article focuses on the optimal treatment of postinfarction, refractory, or recurrent angina based on the results of recent clinical trials. Many of our recommendations hold true for the general management of unstable angina, but special considerations for the high-risk subsets are emphasized. Specifically, we discuss acute medical management and suggest that an early aggressive strategy that leads to early coronary angiography with the goal of revascularization when feasible best serves this subset. A special emphasis on the emerging role of glycoprotein IIb-IIIa antagonists is made because the important role of platelets in coronary thrombosis has dominated recent views on the pathophysiology of unstable angina.
Tung
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Department of Internal Medicine, Northwestern University, McGaw Medical Center, Chicago, Illinois, USA.
Sauri
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Fintel
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Gheorghiade
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D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D017225:Atherectomy, Coronary; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D024764:Hirudin Therapy; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009566:Nitrates / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D006495:Heparin, Low-Molecular-Weight; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin