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Revista Espanola de Cardiologia Jul 2000
Topics: Age Factors; Aged; Aged, 80 and over; Angina, Unstable; Humans
PubMed: 10944987
DOI: No ID Found -
The Journal of Invasive Cardiology Jan 2022Stent fracture is a rather infrequent complication associated with in-stent restenosis, thrombosis, aneurysm formation, and ischemic events. Several stent-related...
Stent fracture is a rather infrequent complication associated with in-stent restenosis, thrombosis, aneurysm formation, and ischemic events. Several stent-related parameters, such as the use of longer or multiple stents, stent overlapping, and balloon/stent overexpansion are potential predictors of stent fracture. Stents deployed in right coronary artery lesions with exaggerated motion, tortuosity, or severe calcification are also generally considered to be at higher risk for fracture. This case demonstrates that intravascular ultrasound imaging is extremely useful to confirm the diagnosis and identify the possible mechanism of the stent fracture, as well as to assess the final result after subsequent angioplasty.
Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Restenosis; Drug-Eluting Stents; Humans; Stents; Treatment Outcome
PubMed: 34982729
DOI: No ID Found -
Journal of the American College of... Apr 1993
Topics: Angina, Unstable; Antithrombin III; Antithrombins; Arginine; Humans; Pipecolic Acids; Recurrence; Sulfonamides; Thrombin
PubMed: 8459056
DOI: 10.1016/0735-1097(93)90223-n -
Postgraduate Medical Journal Apr 1988
Review
Topics: Angina Pectoris; Angina, Unstable; Humans
PubMed: 3054853
DOI: 10.1136/pgmj.64.750.271 -
Clinical Cardiology Apr 2008As I advanced through medical school at Johns Hopkins, and throughout my subsequent training, I was constantly reminded of the contributions made to medicine by our...
As I advanced through medical school at Johns Hopkins, and throughout my subsequent training, I was constantly reminded of the contributions made to medicine by our predecessors. Many of whom were at Johns Hopkins, but many were not. As I continue active involvement in the education of medical students and physicians, it seems to me we have not done a good job of relating the history of how the modern management of patients with cardiovascular disease developed to our students, house staff, and fellows.
Topics: Acute Coronary Syndrome; Angina, Unstable; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Myocardial Infarction
PubMed: 18404680
DOI: 10.1002/clc.20392 -
Clinical Cardiology Apr 1995Obviously, conservative therapy would be less expensive than invasive therapy if patients were held in the conservative category and received only medical therapy along...
Obviously, conservative therapy would be less expensive than invasive therapy if patients were held in the conservative category and received only medical therapy along with exercise test with thallium. However, based on the TIMI 3 B outcomes, costs are similar (but not equal) even if one attempts a conservative strategy since a significant number of patients in the early conservative arm underwent angiography (64 patients) and PTCA (26 patients) or surgery (24 patients) and the number of days for rehospitalization was greater in the early conservative than in the early invasive group. I believe the TIMI 3 B study reflects the reality of clinical practice in 1995. It seems to me that either strategy is acceptable both from the medical and economic outcome standpoints. Given the model used here, I do not think that the early invasive strategy will ever be cheaper than the early conservative strategy unless all of the patients in the early conservative strategy who eventually are revascularized have CABG, and all of the patients in the early invasive strategy who are revascularized have PTCA.
Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Coronary Artery Bypass; Health Care Costs; Humans; Practice Patterns, Physicians'
PubMed: 7788944
DOI: 10.1002/clc.4960180402 -
Mayo Clinic Proceedings Oct 2009The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA),... (Review)
Review
The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization in the United States. A quick but thorough assessment of the patient's history and findings on physical examination, electrocardiography, radiologic studies, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification, which is essential for guiding treatment. High-risk patients with UA/NSTEMI are often treated with an early invasive strategy involving cardiac catheterization and prompt revascularization of viable myocardium at risk. Clinical outcomes can be optimized by revascularization coupled with aggressive medical therapy that includes anti-ischemic, antiplatelet, anticoagulant, and lipid-lowering drugs. Evidence-based guidelines provide recommendations for the management of ACS; however, therapeutic approaches to the management of ACS continue to evolve at a rapid pace driven by a multitude of large-scale randomized controlled trials. Thus, clinicians are frequently faced with the problem of determining which drug or therapeutic strategy will achieve the best results. This article summarizes the evidence and provides the clinician with the latest information about the pathophysiology, clinical presentation, and risk stratification of ACS and the management of UA/NSTEMI.
Topics: Acute Coronary Syndrome; Angina, Unstable; Biomarkers; Coronary Artery Disease; Critical Pathways; Emergency Service, Hospital; Humans; Myocardial Infarction; Risk Assessment
PubMed: 19797781
DOI: 10.4065/84.10.917 -
Journal of the American College of... Mar 1997This study sought to correlate angiographically detected complex lesions and intracoronary thrombus with the severity of clinical presentation in unstable angina (UA).
OBJECTIVES
This study sought to correlate angiographically detected complex lesions and intracoronary thrombus with the severity of clinical presentation in unstable angina (UA).
BACKGROUND
Unstable angina is usually related to acute thrombosis superimposed on a disrupted plaque. Complex and thrombotic lesions are more prevalent in UA and have been associated with a worse prognosis. The highest levels of the Braunwald classification of UA (III = rest angina within 48 h of presentation; C = postinfarction angina; and c = angina refractory to maximal medical therapy) can be used to assess the severity of clinical presentation, but they have not been directly correlated with thrombotic and complex lesions.
METHODS
We conducted a prospective study of 284 patients with UA who underwent cardiac catheterization. A single angiographer with no knowledge of the clinical classifications interpreted all angiograms. Culprit lesions identified in 200 patients were classified as simple or complex. Complex lesions included the categories complex morphology, intracoronary thrombus (ICT) or total occlusion. Lesions were also quantitatively analyzed, and Thrombolysis in Myocardial Infarction (TIMI) flow was assessed. Univariate and multivariate logistic regression analyses of the angiographic findings were performed controlling for all cardiac risk factors, previous angioplasty or bypass surgery and multivessel disease, and we sequentially compared Braunwald classes III, C and c with classes < III, < C and < c, respectively.
RESULTS
Class III was associated with complex lesions (p = 0.04) and decreased TIMI flow (p = 0.03). Class C angina correlated with complex lesions (p = 0.04), ICT (p = 0.005) and decreased TIMI flow (p = 0.03). Class c angina was associated with ICT (p = 0.02). The degree of stenosis by quantitative angiography was not associated with any particular Braunwald class.
CONCLUSIONS
Recent rest pain and refractory or postinfarction UA, or both, are strongly associated with the general category of complex lesions and specifically with angiographically detected ICT and decreased TIMI flow.
Topics: Aged; Angina, Unstable; Coronary Circulation; Coronary Thrombosis; Female; Humans; Male; Middle Aged; Prospective Studies
PubMed: 9060887
DOI: 10.1016/s0735-1097(96)00560-8 -
The Israel Medical Association Journal... Apr 2005Women with myocardial infarction have a less favorable prognosis than men. Many studies have indicated gender bias in the evaluation and treatment of myocardial...
BACKGROUND
Women with myocardial infarction have a less favorable prognosis than men. Many studies have indicated gender bias in the evaluation and treatment of myocardial infarction, but few data exist concerning these aspects in the management of unstable angina.
OBJECTIVE
To investigate gender differences in the baseline characteristics, clinical presentation, treatment and prognosis of women with unstable angina.
METHOD
Data were collected prospectively as part of the Acute Coronary Syndromes Israeli Survey in 2000 at Soroka University Medical Center. In-hospital management and 2 year follow-up were monitored for 226 consecutive patients with unstable angina admitted to our medical center during February and March 2000.
RESULTS
Women were older (71 +/- 12 vs. 66 +/- 12, P = 0.006), more diabetic (41.3% vs. 34.5%, not significant) and hypertensive (76.3% vs. 64.6%, P = 0.07). Women presented more often with atypical chest pain (18.8% vs. 7.5%, P = 0.038). Heparin, aspirin and angiotensin-converting enzyme inhibitor were delivered equally, but more beta-blockers were administered to women (88.5% vs. 75.7%, P = 0.02) and more statins to men (48.1% vs. 35.4%, P = 0.07). Angiography rates were similar (17.7% vs. 19.6%). Similar management was documented during the 2 year follow-up. Re-hospitalization rates were similar (53.3% of women and 63.7% of men, NS). Men had a tendency to develop acute myocardial infarction more often (9.6% vs. 2.7%, P = 0.06) and to develop peripheral vascular disease (3.7% vs. 0%, P = 0.09), and they had a non-significant higher rate of coronary artery bypass graft (6.7% vs. 1.3%, P = 0.08). No gender difference was found in angiography (14.7% of women vs. 16.3% of men) or percutaneous intervention (13% vs. 16.7%). At 2 years there was no gender-related difference in mortality (13.3% of women vs. 16.3% of , NS). Kaplan-Meier analysis for event-free survival after 2 years showed no gender difference in survival. Multi-regression analysis showed that gender was not a prognostic factor for survival.
CONCLUSIONS
We found no major difference in the management of men and women with unstable angina. Although men showed a tendency to suffer more major cardiac events, their 2 year prognosis was the same as for women.
Topics: Aged; Aged, 80 and over; Angina, Unstable; Female; Follow-Up Studies; Hospitalization; Humans; Israel; Male; Middle Aged; Outcome and Process Assessment, Health Care; Prejudice; Prognosis; Prospective Studies; Sex Factors
PubMed: 15847201
DOI: No ID Found -
Heart (British Cardiac Society) Jun 1999
Topics: Angina, Unstable; Cardiac Catheterization; Humans; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Thrombolytic Therapy
PubMed: 10336909
DOI: 10.1136/hrt.81.6.565