Thrombolytics and Invasive vs Conservative Strategies

  • Shilpesh S. Patel
  • H. Vernon Anderson
Part of the Contemporary Cardiology book series (CONCARD)


The coronary syndromes of unstable angina pectoris and non-Q-wave myocardial infarction (NQMI) represent a pathophysiologic continuum all the way from brief myocardial ischemia to partial, nontransmural myocardial necrosis. The clinical presentation of these two syndromes is identical, typically consisting of intermittent episodes of chest pain lasting from only a few minutes to hours, and occurring either at rest or with minimal exertion. Patients with unstable angina, by definitygn, sustain only myocardial ischemia, whereas patients with NQMI, by definition, sustain at least some myocardial necrosis as evidenced by the leakage of creatine phosphokinase-MB, troponin T, and troponin I, but without the development of Q-waves on the electrocardiogram. Thus, NQMI can be viewed as a manifestation of more prolonged or severe unstable angina. Clinically the two syndromes are similar with respect to cardiovascular mortality and morbidity. They may be thought of as warning signs of impending or threatening myocardial infarction (MI). Older natural history studies (1–3) have shown that the development of unstable angina is associated within a year with a 10%–20% incidence of death and a 20%–40% incidence of nonfatal MI. In addition, in more recent studies, 60% of patients hospitalized with unstable angina typically have required revascularization with either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CAB G) within 1 yr.


Unstable Angina Coronary Angioplasty Thrombolytic Agent Impaired Left Ventricular Function Recurrent Ischemia 
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© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Shilpesh S. Patel
  • H. Vernon Anderson

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