Key result
Risk stratification in non-ST elevation acute coronary syndromes guides the use of medical therapy, glycoprotein IIb/IIIa inhibitors, and early revascularization for high-risk patients.
This review summarizes the contemporary risk-stratified management of non-ST elevation acute coronary syndromes, emphasizing early invasive strategies for high-risk patients.
Supports risk-stratified NSTE-ACS care; leaves open need for updated RCTs with contemporary therapies.
This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe.
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G A. Large (2005) conducted a review in Non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Contemporary management (medical therapy, risk stratification, and revascularization) was evaluated. Risk stratification in non-ST elevation acute coronary syndromes guides the use of medical therapy, glycoprotein IIb/IIIa inhibitors, and early revascularization for high-risk patients.
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