Skip to main content
SpringerLink
Log in

Early-invasive or early-conservative management of patients with unstable angina or non-Q-wave myocardial infarction

  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

The optimal therapy for non-ST-segment-elevation acute coronary syndromes is the subject of considerable debate: is early catheterization and revascularization (early-invasive strategy) or continued medical therapy unless symptoms are refractory (early-conservative strategy) best? Although several clinical trials have sought to answer this question, the methodologies they employed have been widely criticized, and no consensus has been reached. The new antiplatelet therapies have proved beneficial for primary medical management and as adjuncts to percutaneous interventions. It is not yet clear, however, whether use of these therapies will preferentially benefit one of the treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kong DF, Califf RM, Miller DP, et al. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb /IIIa integrin in ischemic heart disease.Circulation. 1998; 98: 2829–2835.

    PubMed  CAS  Google Scholar 

  2. Vorchheimer DA, Badimon JJ, Fuster V. Platelet glycoprotein IIb/IIIa receptor antagonists in cardiovascular disease.JAMA. 1999; 281: 1407–1414.

    Article  PubMed  CAS  Google Scholar 

  3. Topol EJ. What role for catheter laboratories in unstable angina?Lancet. 1998; 352: 500–501.

    Article  PubMed  CAS  Google Scholar 

  4. Chen L, Chester MR, Redwood S, Huang J, Leatham E, Kaski JC. Angiographic stenosis progression and coronary events in patients with ‘stabilized’ unstable angina.Circulation. 1995; 91: 2319–2324.

    PubMed  CAS  Google Scholar 

  5. Adgey AA, Mathew TP, Harbinson MT. Periprocedural creatine kinase-MB elevations: longterm impact and clinical implications.Clin Cardiol. 1999; 22: 257–265.

    Article  PubMed  CAS  Google Scholar 

  6. Narins CR, Miller DP, Califf RM, Topol EJ. The relationship between periprocedural myocardial infarction and subsequent target vessel revascularization following percutaneous coronary revascularization: insights from the EPIC trial.J Am Coll Cardiol. 1999; 33: 647–653.

    Article  PubMed  CAS  Google Scholar 

  7. Braunwald E, Mark DB, Jones RH, et al.Unstable Angina: Diagnosis and Management. Clinical Practice Guideline Number 10. Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1994. AHCPR Publication No. 94-0602.

    Google Scholar 

  8. The TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Results of the TIMI IIIB Trial.Circulation. 1994; 89: 1545–1556.

    Google Scholar 

  9. Anderson HV, Cannon CP, Stone PH, et al. One-year results of the Thrombolysis In Myocardial Infarction (TIMI) IIIB clinical trial. A randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction.J Am Coll Cardiol. 1995; 26: 1643–1650.

    Article  PubMed  CAS  Google Scholar 

  10. Boden WE, O’Rourke RA, Crawford MH, the Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. 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: 1785–1792.

    Article  PubMed  CAS  Google Scholar 

  11. Tu JV, Sykora K, Naylor CD. Steering Committee of the Cardiac Care Network of Ontario. Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough?J Am Coll Cardiol. 1997; 30: 1317–1323.

    Article  PubMed  CAS  Google Scholar 

  12. Madsen JK, Grande P, Saunamaki K, et al. Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI).Circulation. 1997; 96: 748–755.

    PubMed  CAS  Google Scholar 

  13. Yusuf S, Flather M, Pogue J, the OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation.Lancet. 1998; 352: 507–514.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Akkerhuis M, Boersma E, Harrington RA, Deckers JW, Califf RM, Simoons ML. Eptifibatide protects against adverse cardiac complications both before and during percutaneous intervention in patients with acute coronary syndromes without ST-elevation.J Am Coll Cardiol. 1999; 33(suppl A): 40A.

    Google Scholar 

  16. Topol EJ, Serruys PW. Frontiers in interventional cardiology.Circulation. 1998; 98: 1802–1820.

    PubMed  CAS  Google Scholar 

  17. Topol EJ. Coronary-artery stents—gauging, gorging, and gouging.N Engl J Med. 1998; 339: 1702–1704.

    Article  PubMed  CAS  Google Scholar 

  18. The EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplastycontrolled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/ IIIa blockade.Lancet. 1998; 352: 87–92.

    Article  Google Scholar 

  19. The OASIS Investigators. Comparison of the effects of two doses of recombinant hirudin compared with heparin in patients with acute myocardial ischemia without ST elevation: a pilot study.Circulation. 1997; 96: 769–777.

    Google Scholar 

  20. The OASIS-2 Investigators. Effects of recombinant hirudin (lepirudin) compared with heparin on death, myocardial infarction, refractory angina, and revascularisation procedures in patients with acute myocardial ischaemia without ST elevation: a randomised trial.Lancet. 1999; 353: 429–438.

    Article  Google Scholar 

  21. The FRISC Study Group. Low-molecular-weight heparin during instability in coronary artery disease.Lancet. 1996; 347: 561–568.

    Google Scholar 

  22. Klein W, Buchwald A, Hillis SE, et al. Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease: Fragmin in Unstable Coronary Artery Disease Study.Circulation. 1997; 96: 61–68.

    PubMed  CAS  Google Scholar 

  23. Cohen M, Demers C, Gurfinkel EP, 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.

    Article  PubMed  CAS  Google Scholar 

  24. Cairns JA, Gill J, Morton B, et al. Fish oils and low-molecular-weight heparin for the reduction of restenosis after percutaneous transluminal coronary angioplasty. The EMPAR Study.Circulation. 1996; 94: 1553–1560.

    PubMed  CAS  Google Scholar 

  25. Karsch KR, Preisack MB, Baildon R, et al. Low molecular weight heparin (reviparin) in percutaneous transluminal coronary angioplasty: results of a randomized, double-blind, unfractionated heparin and placebo-controlled, multicenter trial (REDUCE Trial).J Am Coll Cardiol. 1996; 28: 1437–1443.

    Article  PubMed  CAS  Google Scholar 

  26. The FRISC II Investigators. Invasive compared with non-invasive treatment in unstable coronaryartery disease: FRISC II prospective randomised multicentre study.Lancet. 1999; 354: 708–715.

    Article  Google Scholar 

  27. Cannon CP, Weintraub WS, Demopoulos LA, Robertson DH, Gormley GJ, Braunwald E. Invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction following treatment with tirofiban: rationale and study design of the international TACTICS-TIMI 18 Trial.Am J Cardiol. 1998; 82: 731–736.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Scripps Memorial Hospital, 9850 Genesee Avenue, Suite 940, 92037, LaJolla, CA

    Dennis Goodman M.D., F.A.C.C., F.A.C.P.

Authors
  1. Dennis Goodman M.D., F.A.C.C., F.A.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goodman, D. Early-invasive or early-conservative management of patients with unstable angina or non-Q-wave myocardial infarction. Adv Therapy 17, 45–55 (2000). https://doi.org/10.1007/BF02868030

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02868030

Keywords

Search

Navigation