[Early intervention in acute coronary syndromes (unstable angina and non-Q wave infarction].
The timing for coronary angiography and revascularization in unstable angina and infarction without Q-wave in patients without high-risk characteristics after arrival to the hospital is uncertain. If high-risk patients are not considered, there are several therapeutical strategies for the diagnosis and treatment of the patients. The first is a conservative approach, in which coronary angiography and revascularization is done only in patients presenting angina or electrocardiographic changes of ischemia after arrival to the hospital. The other one is an invasive approach, in which coronary angiography and revascularization procedure are done few days after arrival to the hospital. Several studies, in the last decade, have compared both types of therapeutical strategies in patients with unstable angina and infarction without Q-wave (TIMI IIIB, FRISC II and VANQWISH). The results of these studies were uncertain and showed that there are no advantages regarding mortality or infarction with either therapeutic approach. However, some subsets of patients benefited from the invasive approach (patients > or = 65 years, angina or electrocardiographic changes in S-T segment during the time of hospitalization). On the other side, all these studies showed that with the invasive approach there is less incidence of recurrent ischemic events during the time of hospitalization and at long range, as well as an improvement in the functional class of ischemia, and in long-range quality of life as well as a marked reduction in hospital stay. In conclusion, an early invasive approach could be justified in patients with unstable angina presenting low and intermediate risk factors.
Villavicencio
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Servicio de Hemodinamia, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, 14080 México, D.F.
D000208:Acute Disease; D000789:Angina, Unstable / Q000628:therapy*; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors