Early management of unstable angina and non-ST segment elevation myocardial infarction: summary of NICE guidance

Crowe, Emily; Lovibond, Kate; Gray, Huon; Henderson, Robert A.; Krause, Taryn; Camm, John

doi:10.1136/bmj.c1134

Cited by 12 publications

(5 citation statements)

References 1 publication

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“…Risk reduction in patients with chronic stable angina is similar, although certainly not identical to, the risk management in primary prevention,194 guidelines written specifically for women,195 guidelines for secondary prevention generally,196 and European guidelines for prevention of heart disease 197–200. Related guidelines of interest include those for unstable angina/NSTEMI,173,201,202 exercise testing203 and the ACC/AHA/SCAI updates on PCI 204…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Kones¹

2010

VHRM

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The objectives in treating angina are relief of pain and prevention of disease progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, β-blockers, and calcium channel blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS), are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD) – smoking, hypertension, dyslipidemia, diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI) with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in whom medical therapy fails, and in those with acute coronary syndromes, PCI is indicated. Asymptomatic patients with CAD and those with stable angina may defer intervention without additional risk to see if they will improve on optimum medical therapy. For many patients, coronary artery bypass surgery offers the best opportunity for relieving angina, reducing the need for additional revascularization procedures and improving survival. Optimal medical therapy, percutaneous coronary intervention, and surgery are not competing therapies, but are complementary and form a continuum, each filling an important evidence-based need in modern comprehensive management.

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Section: Calcium Channel Blockersmentioning

confidence: 99%

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Kones¹

2010

VHRM

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“…First, the treatment of a particular condition may be addressed in multiple clinical practice guidelines, issued by different disciplines involved in the treatment of the same condition, for care provided in different clinical settings or countries, or for care financed by different third-party payers. (e.g., 53, 54, 55, 56, 57, 58) Consequently, operative standards of care may depend on where a trial is conducted. In multicenter trials, standards of care may differ across centers.…”

Section: Introductionmentioning

confidence: 99%

Usual and Unusual Care

Freedland

Mohr

Davidson

et al. 2011

Psychosomatic Medicine

292

135

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Objective To examine the use of existing practice control groups in randomized controlled trials of behavioral interventions, and the role of extrinsic healthcare services in the design and conduct of behavioral trials. Method Selective qualitative review. Results Extrinsic healthcare services, also known as nonstudy care, have important but under-recognized effects on the design and conduct of behavioral trials. Usual care, treatment as usual, standard of care, and other existing practice control groups pose a variety of methodological and ethical challenges, but they play a vital role in behavioral intervention research. Conclusion This review highlights the need for a scientific consensus statement on control groups in behavioral trials.

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“…[4][5][6] This expedited treatment algorithm is designed to reduce the risk of recurrent myocardial infarction, but, as a consequence, most patients do not undergo noninvasive assessment of left ventricular function and/or myocardial viability before cardiac catheterization. At present, there are no invasive tools for assessing myocardial viability in the catheterization laboratory, as an adjunct to coronary angiography.…”

mentioning

confidence: 99%

Coronary Wave Energy

Silva

Foster

Guilcher

et al. 2013

Circ: Cardiovascular Interventions

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Background-Revascularization after acute coronary syndromes provides prognostic benefit, provided that the subtended myocardium is viable. The microcirculation and contractility of the subtended myocardium affect propagation of coronary flow, which can be characterized by wave intensity analysis. The study objective was to determine in acute coronary syndromes whether early wave intensity analysis-derived microcirculatory (backward) expansion wave energy predicts late viability, defined by functional recovery. Methods and Results-Thirty-one patients (58±11 years) were enrolled after non-ST elevation myocardial infarction.Regional left ventricular function and late-gadolinium enhancement were assessed by cardiac magnetic resonance imaging, before and 3 months after revascularization. The backward-traveling (microcirculatory) expansion wave was derived from wave intensity analysis of phasic coronary pressure and velocity in the infarct-related artery, whereas mean values were used to calculate hyperemic microvascular resistance.

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Early management of unstable angina and non-ST segment elevation myocardial infarction: summary of NICE guidance

Cited by 12 publications

References 1 publication

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Usual and Unusual Care

Coronary Wave Energy

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