Circulation. 1998;97:1195-1206
(Circulation. 1998;97:1195-1206.)
© 1998 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
Acute Coronary Syndromes
Unstable Angina and Non–Q-Wave Myocardial Infarction
Pierre Théroux, MD;
; Valentin Fuster, MD, PhD
From the Montreal Heart Institute and University of Montreal, Quebec,
Canada (P.T.), and the Cardiovascular Institute, Mount Sinai Medical Center,
New York, NY (V.F.).
Correspondence to Pierre Théroux, MD, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada H1T 1C8.
Key Words: angina • myocardial infarction • platelets • platelet aggregation inhibitors • thrombosis • heparin
Ischemic
heart disease includes a wide spectrum of conditions, ranging from
silent ischemia and exertion-induced angina, through unstable
angina, to acute MI. Unstable angina occupies the center of this
spectrum, causing disability and risk greater than that of chronic
stable angina but less than that of acute MI1
(Fig 1
). Although non–Q-wave MI for many
years was considered prognostically similar to unstable angina, recent
longitudinal studies indicate that it is similar to Q-wave
infarction2 3 (Fig 2).
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Figure 1. Cumulative 6-month mortality from ischemic
heart disease. Diagnosis on admission to hospital (n=21 761; 1985 to
1992). From Duke Cardiovascular Database. Reproduced
with permission from Reference 1.
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Figure 2. Top, Cumulative 1-year combined death or MI among
patients with Q-wave and non–Q-wave MI treated with
fibrinolysis. Reproduced with permission from Reference
2. Bottom, Risk of subsequent cardiac events in stable convalescing
patients after first non–Q-wave and Q-wave MI. Reproduced with
permission from Reference 3.
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The concept of unstable angina has emerged from observations of
frequent symptoms preceding acute MI, followed by prospective
documentation that unstable symptoms frequently culminated in acute MI.
The syndrome was rapidly accepted as a well-defined clinical entity as
specific clinical manifestations,
pathophysiological mechanisms, laboratory findings,
and treatment became better characterized. Unstable angina is currently
one of the leading causes of hospital admission for CAD, and
non–Q-wave MI accounts for >30% of admissions for acute
MI.1 4 Yet, the diagnosis of unstable angina
remains clinical, based on symptom recognition. The physician caring
for patients with unstable angina is . . . [Full Text of this Article]
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