Unstable angina and non-ST-segment elevation myocardial infarction: part II. Coronary revascularization, hospital discharge, and post-hospital care.
In the guideline developed by the American College of Cardiology and the American Heart Association, the management of suspected unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) has four components: initial evaluation and management; hospital care; coronary revascularization; and hospital discharge and post-hospital care. Part II of this two-part article discusses coronary revascularization, hospital discharge, and post-hospital care. Decisions must be made about the use of coronary angiography and coronary revascularization in patients hospitalized with UA/NSTEMI. With an early conservative strategy, medical management is employed. Coronary angiography and revascularization are reserved for use in patients with evidence of ischemia at rest (or with minimal activity) and patients with a strongly positive stress test. With an early invasive strategy, coronary angiography and revascularization are recommended within 48 hours in patients without contraindications. Hospital discharge planning involves coordination of medical care, preparation of the patient for resumption of normal activities, and evaluation of the need for long-term risk factor reduction. Discharge medications should be continued to control ongoing symptoms (anti-ischemic agents) and prevent recurrent events (aspirin, clopidogrel, beta blocker, and an angiotensin-converting enzyme inhibitor or statins in selected patients).
Thrombolysis in Myocardial Infarction Study Group, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
Stephen D
SD
Wiviott
Eugene
E
Braunwald
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery / Q000628:therapy*; D010351:Patient Discharge; D012307:Risk Factors