Abstract
The establishment of a prognosis and the approach to the treatment of many diseases is aided greatly by a logical classification. For example, classification of a wide variety of neoplasms by anatomic extent, microscopic appearance, and the presence of special markers now forms the basis for selecting appropriate therapy. In cardiology, the classification of patients with acute myocardial infarction and congestive heart failure has been of enormous value in following the progress and in selecting therapy of individual patients and in comparing the outcome of similar patients treated at different locations and at different times. The purpose of this article is to provide a classification of unstable angina. This classification is designed to facilitate communication about these patients, to aid in the decision regarding diagnostic measures and therapy of individual patients, and to provide a more precise basis for including patients in and for evaluating the outcome of clinical trials.
This paper was originally published in Circulation 80:410–414, 1989, and it is reproduced here by permission of the American Heart Association, Inc.
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References
Wearn JT (1923) Thrombosis of the coronary arteries, with infarction of the heart. Am J Med Sci 165: 250–276
Sampson JJ, Eliaser M Jr (1937) The diagnosis of impending acute coronary artery occlusion. Am Heart J 13: 675–686
Feil H (1937) Preliminary pain in coronary thrombosis. Am J Med Sci 193: 42–48
Scanlon PJ, Nemickas R, Moran JF, Talano JV, Amirparviz F, Pifarre R (1973) Accelerated angina pectoris: clinical hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation 47: 19–26
Wood P (1961) Acute and subacute coronary insufficiency. Br Med J 1: 1779–1782
Vakil RJ (1961) Intermediate coronary syndrome. Circulation 24: 557–571
Vakil RJ (1964) Preinfarction syndrome: management and follow-up. Am J Cardiol 14: 55–63
Fowler NO (1971) “Preinfarctional” angina: A need for an objective definition and for a controlled clinical trial of its management. Circulation 44:755–758
Conti CR, Greene B, Pitt B, Griffith L, Humphries O, Brawley R, Taylor D, Bender H, Gott V, Ross RS (1971) Coronary surgery in unstable angina pectoris (abstract). Circulation 44 (Suppl II): II-154
Patterson DLH (1988) Unstable angina. Postgrad Med J 64: 196–200
Patterson DLH (1988) Management in unstable angina. Postgrad Med J 64: 271–277
Bertolasi CA, Tronge JE, Mon GA, Turri D, Lugones MI (1979) Clinical spectrum of “unstable angina.” Clin Cardiol 2: 113–120
Julian DG (1985) The natural history of unstable angina, in Hugenholtz PG, Goldman BS (eds) Unstable angina: current concepts and management. Stuttgart, Schattauer, pp 65–70
National Center for Health Statistics (1987) Vital and health statistics: detailed diagnosis and procedures for patients discharged from short stay hospitals. US Department of Health and Human Services, Public Health Service, Series 13, No. 90, Hyattsville, Md.
Falk E (1985) Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 71: 699–708
Harper RW, Kennedy G, DeSanctis RW, Hutter AM (1979) The incidence and pattern of angina prior to acute myocardial infarction: a study of 577 cases. Am Heart J 97: 178–183
Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J (1988) Insights into the pathogenesis of acute ischemic syndromes. Circulation 6:1213–1220
Maseri A (1986) Pathogenetic classifications of unstable angina as a guideline to individual patient management and prognosis. Am J Med 80 (Suppl 4C): 48–55
Moise A, Theroux P, Taeymans Y, Descoings B, Lesperance J, Waters DD, Pelletier GB, Bourassa M (1983) Unstable angina and progression of coronary atherosclerosis. N Engl J Med 309: 685–689
Ambrose JA, Winters SL, Arora RR, Eng A, Ricco A, Gorlin R, Fuster V (1986) Angiographic evolution of coronary artery morphology in unstable angina. J Am Coll Cardiol 7: 472–478
Holmes DR Jr, Hartzler GO, Smith HC, Fuster V (1981) Coronary artery thrombosis in patients with unstable angina. Br Heart J 45: 411–416
Vetrovec GW, Cowley MJ, Overton H, Richardson DW (1981) Intracoronary thrombus in syndromes of unstable myocardial ischemia. Am Heart J 102: 1202–1208
Capone G, Wolf NM, Meyer B, Meister SG (1985) Frequency of intracoronary filling defects by angiography in angina pectoris at rest. Am J Cardiol 56: 403–406
Gotoh K, Katoh K, Fukui S, Hamano Y, Minamino T (1985) Angiographic visualization of coronary thrombus during anginal attack in unstable angina (abstract). Circulation 72 (Suppl III) III-112
Sherman CT, Litvack F, Grundfest ME, Lee M, Hickey A, Chaux A, Kass R, Blanche C, Matloff J, Morgenstern L, Ganz W, Swan HJC, Forrester J (1986) Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 315: 913–919
Falk E (1983) Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J 50: 127–134
Fitzgerald DJ, Roy L, Catella F, Fitzgerald GA (1986) Platelet activation in unstable coronary disease. N Engl J Med 315: 983–989
Haerem JW (1974) Mural platelet microthrombi and major acute lesions of main epicardial arteries in sudden coronary death. Atherosclerosis 19: 529–541
Ross J Jr, Gilpin EA, Madsen EB, Henning H, Nicod P, Dittrich H, Engler R, Rittelmeyer J, Smith SC, Viquerat C (1989) A decision scheme for coronary angiography after acute myocardial infarction. Circulation 79: 292–303
Ross J Jr, Bradenburg RO, Dinsmore RE, Friesinger GC II, Hultgren HH, Pepine CJ, Rapaport E, Ryan TJ, Weinberg SL, Williams JF (1987) Guidelines for coronary angiography: Report of the Joint American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures. J Am Coll Cardiol 10:935–950 and Circulation 76: 963A–977A
Breyer RH, Engelman RM, Rousou JA, Lemeshow S (1985) Postinfarction angina: an expanding subset of patients undergoing coronary artery bypass. J Thorac Cardiovasc Surg 90: 532–540
DeBusk RF, Blonqvist CG, Kochoukos NT, Luepker RV, Miller HS, Moss AJ, Pollock ML, Reeves TJ, Selvester RH, Stason WB, Wagner GS, Willman VL (1986) Identification and treatment of low-risk patients after acute myocardial infarction and coronary-artery bypass graft surgery. N Engl J Med 314: 161–166
Gazes PC, Mobley EM Jr, Farris HM Jr, Duncan RC, Humphries GB (1973) Preinfarctional (unstable) angina — a prospective study: ten year follow-up. Circulation 48: 331–337
Haines DE, Raabe DS, Gundel WD, Wackers FJ (1983) Anatomic and prognostic significance of new T-wave inversion in unstable angina. Am J Cardiol 52: 14–18
Sclarovsky S, Davidson E, Lewin RF, Strasberg B, Arditti A, Agmon J (1986) Unstable angina pectoris evolving to acute myocardial infarction: significance of ECG changes during chest pain. Am Heart J 112: 459–462
Sclarovsky S, Davidson E, Strasberg B, Lewin RF, Arditti A, Wurtzel M, Agmon J (1986) Unstable angina: the significance of ST segment elevation or depression in patients without evidence of increased myocardial oxygen demand. Am Heart J 112: 463–467
Plotnick GD, Greene HL, Carliner NH, Becker LC, Fisher ML (1979) Clinical indicators of left main coronary artery disease in unstable angina. Ann Intern Med 91: 149–153
Papapietro SE, Niess GS, Paine TD, Mantle JA, Rackley CE, Russell RO, Rogers WJ (1980) Transient electrocardiographic changes in patients with unstable angina: relation to coronary arterial anatomy. Am J Cardiol 46: 28–33
Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE III, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chester E, DeMots H (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 309: 396–403
Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, Pelletier E, Juneau M, Stasiak J, DeGruise P, Pellitier GB, Rinzler D, Waters DD (1988) Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med 319: 1105–1111
Gold HK, Johns JA, Leinbach RC, Yasuda T, Grossbard E, Zusman R, Collen D (1987) A randomized, blinded, placebo-controlled trial of recombinant human tissue-type plasminogen activator in patients with unstable angina pectoris. Circulation 75: 1192–1199
Topol EJ, Nicklas JM, Kander NH, Walton JA, Ellis SG, Gorman L, Pitt B (1988) Coronary revascularization after intravenous tissue plasminogen activator for unstable angina pectoris: results of a randomized double-blind, placebo-controlled trial. Am J Cardiol 62: 368–371
de Zwaan C, Bar FW, Janssen JHA, de Swart HB, Vermeer F, Wellens HJJ (1988) Effects of thrombolytic therapy on unstable angina: clinical and angiographic results. J Am Coll Cardiol 12: 301–309
Williams DO, Riley RS, Singh AK, Gerwitz H, Most AS (1981) Evaluation of the role of coronary angioplasty in patients with unstable angina pectoris. Am Heart J 102: 1–90
De Feyter PJ, Suryapranata H, Serruys PW, Beatt K, van Domburg R, van den Brand M, Tijssen JJ, Azar AJ, Hugenholtz PG (1988) Coronary angioplasty for unstable angina: immediate and late results in 200 consecutive patients with identification of risk factors for unfavorable early and late outcome. J Am Coll Cardiol 12: 324–333
Favaloro RG, Effler DB, Cheanvechai C, Quint RA, Sones FM Jr (1971) Acute coronary insufficiency (impending myocardial infarction and myocardial infarction). Am J Cardiol 28: 598–607
Unstable Angina Pectoris Study Group: Unstable angina pectoris (1978) National cooperative study group to compare surgical and medical therapy. II. In-hospital experience and initial follow-up results in patients with one, two and three vessel disease. Am J Cardiol 42: 839–848
Luchi RJ, Scott SM, Deupree RH, and the Principal Investigators and Their Associates of Veterans Administration Cooperative Study No. 28 (1987) Comparison of medical and surgical treatment for unstable angina pectoris. N Engl J Med 316: 977–984
Curfman GD, Heinsimer JA, Lozner EC, Ho-Leung F (1983) Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial. Circulation 67: 276–282
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Braunwald, E. (1990). Unstable Angina: A Classification. In: Bleifeld, W., Hamm, C.W., Braunwald, E. (eds) Unstable Angina. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-61288-6_7
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DOI: https://doi.org/10.1007/978-3-642-61288-6_7
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