Non-Q-Wave myocardial infarction
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The treatment of non-Q-wave infarction involves the use of antithrombotic therapy (aspirin and heparin) along with appropriate antianginal medication to reduce myocardial oxygen demands and prevent coronary spasm. In certain high-risk patient subgroups (ie, those with recurrent ischemia, persistent or significant ST segment change, congestive heart failure, or hypotension with chest pain), the use of newer agents such as the platelet glycoprotein IIb/IIIa antagonists is indicated. The role of angiography appears to be changing. In the past, at least in the United States, angiography was performed on nearly all patients with non-Q-wave infarction. Now, risk stratification into high- and low-risk subgroups can be performed based on clinical criteria. In low-risk individuals, we recommend that noninvasive testing be performed before a decision is made about an invasive evaluation. In high-risk patients, it is appropriate to perform angiography and, based on the angiographic findings, to provide appropriate therapy. Although the results of the Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) study suggest that if bypass surgery is required, it should not be performed acutely, we do not believe that this is necessarily correct. Therapy must be individualized based on the risk-benefit profile of acute revascularization. Furthermore, the use of percutaneous coronary intervention, particularly with the glycoprotein IIb/IIIa antagonists and stents, is expanding to include multivessel disease, even in the presence of left ventricular dysfunction. Again, we believe therapy must be individualized to include an estimate of short- and long-term risk versus benefit. In the future, however, more data from appropriately designed clinical trials will be required to establish evidence-based therapy.
- Ambrose JA: A Plaque disruption and the acute coronary syndromes of unstable angina and myocardial infarction: if the substrate is similar, why is the clinical presentation different? J Am Coll Cardiol 1992, 19:1653–1658. CrossRef
- Nicod P, Gilpin E, Dittrich H, et al.: Short and long term clinical outcome after Q-wave and non-Q-wave myocardial infarction in a large patient population. Circulation 1989, 79:528–536.
- Ogawa H, Hiramuri K, Haze K, et al.: Comparison of clinical features of non-Q-wave infarction and Q-wave myocardial infarction. Am Heart J 1986, 111:513–518. CrossRef
- Schechtman KB, Capone RJ, Kleiger RE, et al. for the Diltiazem Reinfarction Study Research Group: Risk stratification of patients with non-Q-wave myocardial infarction. The critical role of ST segment depression. Circulation 1989, 80:1148–1158.
- Armstrong PW, Fu Y, Change WC, et al.: Acute ischemic syndromes in GUSTO IIb trial. Prognostic insights and impact of recurrent ischemia. Circulation 1998, 98:1860–1868.
- Liebson P, Klein L: The non-Q-wave myocardial infarction revisited: 10 years later. Prog Cardiovasc Dis 1997, 34(5):399–444. Extensive review of non-Q-wave infarction, well referenced. CrossRef
- Boden W, O’Rourke R, Crawford M, et al.: Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med 1998, 338(25):1785–1792. Only randomized study available. CrossRef
- Boden W, Kleiger R, Gibson R, et al.: Favorable long term prognosis in patients with non-Q-wave acute myocardial infarction not associated with specific electrocardiographic changes. Br Heart J 1989, 61:396–402.
- Klimt C, Knatterud G, Stampler E, et al.: Persantine-Aspirin Reinfarction Study. Part II. Secondary coronary prevention with persantine and aspirin. J Am Coll Cardiol 1986, 7:251–269. CrossRef
- The RISC Group: Risk of myocardial infarction and death during treatment with low-dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990, 336:827–830. CrossRef
- Gantt A, Gantt S: Comparison of enteric coated aspirin and uncoated aspirin effect on bleeding time. Cathet Cardiovasc Diagn 1998, 45:396–399. CrossRef
- Gheorgiade M, Schultz L, Tilley B, et al.: Effects of propranolol in non-Q-wave acute myocardial infarction in the beta blocker heart attack trial. Am J Cardiol 1990, 66:129–133. CrossRef
- Roode BE: The Timolol Myocardial Infarction Study: an evaluation of selected variables. Circulation 1983, 67(suppl I):I101-I106.
- Gibson R, Boden W, Theroux P, et al.: Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. N Engl J Med 1986, 315(7):423–429. CrossRef
- The Multicenter Diltiazem Postinfarction Trial Research Group: The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med 1988, 319(7):385–392. CrossRef
- The Holland Inter University Nifedipine/Metoprolol Trial (HINT) Research Group: Early treatment of unstable angina in the coronary care unit: a randomized, double-blind, placebo controlled comparison of recurrent ischemia in patients treated with nifedipine or metoprolol or both. Br Heart J 1986, 56:400–413.
- Oler A, Whooky M, Oler J, et al.: Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. JAMA 1996, 276:811–815. CrossRef
- FRISC Study Group: Low-molecular-weight heparin during instability in coronary artery disease: FRagmin during InStability in Coronary artery disease (FRISC) study group. Lancet 1996, 347:561–568.
- Klein W, Buchwald A, Hillis S, et al.: Comparison of low molecular weight heparin with UFH acutely and with placebo for 6 weeks in the management of unstable coronary artery disease: the Fragmin in Unstable Coronary Artery Disease Study (FRIC). Circulation 1997, 96:61–68.
- Cohen M, Demers C, Gurfinkel E, et al.: A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997, 337:447–452. CrossRef
- Antman EM, McCabe CH, Gurfinkel EP, et al.: Enoxaprin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction: results of the Thrombolysis In Myocardial Infarction (TIMI) 11B trial. Circulation 1999, 100(15):1593–1601.
- Madon M, Berkowitz S, Tcheng J: Glycoprotein IIb/IIIa integrin blockade. Circulation 1998, 98:2629–2635. Excellent review of the use of this drug.
- The PURSUIT Trial Investigators: Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med 1998, 339:436–443. CrossRef
- The PRISM PLUS Study Investigators: Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med 1998, 338:1488–1497. CrossRef
- The CAPTURE Investigators: Randomized placebocontrolled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 1997, 349:1429–1435. CrossRef
- Klein J, Froelicher V, DeTrano R, et al.: Does the resting electrocardiogram after myocardial infarction determine the predictive value of exercise-induced ST depression? A 2 year follow-up study in a veteran population. J Am Coll Cardiol 1989, 14:305–311. CrossRef
- Larrson H, Areskog M, Areskog N, et al.: Should the exercise test be performed at discharge or one month later after an episode of unstable angina or non-Q-wave infarction? Int J Card Imaging 1991, 7:7–14. CrossRef
- Non-Q-Wave myocardial infarction
Current Treatment Options in Cardiovascular Medicine
Volume 2, Issue 1 , pp 19-26
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links