[Treatment of unstable angina: early invasive strategy].
Unstable angina is one of the main reasons for admission to a cardiology department and the risk of myocardial infarction is high. Non-Q wave myocardial infarction used to be assimilated to unstable angina. Myocardial infarction without prolonged ST segment elevation and with troponin increase is now the category used to describe this condition. CPK elevation, EKG and clinical parameters are involved in the acute prognosis of patients with unstable coronary syndrome. The FRISC II trial was the first study to demonstrate the superiority of systematic early angiography followed by a revascularization procedure selected according to the type of lesions to be treated, compared with conventional management. The use of stents combined with GPIIb/IIIa inhibitors has increased the safety of PTCA and seems to have a synergetic effect. The superiority of early invasive management using stents and GPIIb/IIIa inhibitors was confirmed by the TACTICS. The risks of bleeding complications associated with this therapeutic strategy are minimized by the TIMI classification. This classification no longer corresponds to the current norms of patient safety and comfort. Several methods can be used in order to decrease the risk of bleeding complications; the radial approach is undoubtedly the most efficient one.
Louvard
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ICPS, Institut Jacques Cartier, Massy, hôpital Claude Galien, Quincy, HEP la Roseraie, 120, avenue de la République, 93308 Aubervilliers, France.
D000789:Angina, Unstable / Q000601:surgery*; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology
D019039:Platelet Glycoprotein GPIIb-IIIa Complex