Current management of non-ST-segment-elevation acute coronary syndrome: reconciling the results of randomized
Abhiram Prasad1, Verghese Mathew, David R Holmes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
European Heart Journal
|August 21, 2003
Summary
For non-ST-segment-elevation acute coronary syndrome, an early invasive strategy with risk stratification improves outcomes. Higher-risk patients benefit from prompt angiography and revascularization, while lower-risk patients can undergo stress testing.
Area of Science:
- Cardiology
- Acute Coronary Syndromes
Background:
- Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients are a heterogeneous group.
- Conventional treatment involves hospitalization for stabilization, with choices between conservative or invasive strategies.
- Treatment decisions often depend on local practices and facility availability.
Purpose of the Study:
- To outline criteria for risk stratification in NSTE-ACS patients.
- To recommend an early risk stratification and revascularization-based approach.
- To compare the effectiveness of invasive versus conservative strategies.
Main Methods:
- Review of recent randomized trials comparing invasive and conservative strategies.
- Development of criteria for risk stratification using clinical features, ECG, and biomarkers.
- Assessment of risk stratification at presentation.
Main Results:
- Invasive strategy is superior, especially for higher-risk patients.
- Randomized trials provide data for refining risk stratification.
- Glycoprotein IIb/IIIa receptor inhibitors are indicated for specific interventions.
Conclusions:
- Higher-risk patients require early angiography (within 48h) and potential revascularization.
- Lower-risk patients may be managed in chest pain units with subsequent stress testing.
- This approach reduces recurrent myocardial infarction, ischemia, hospitalizations, and mortality.
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