Skip to main content
SpringerLink
Log in

Therapy for Acute Coronary Syndrome and Unstable Angina

  • Chapter
Pathophysiology and Pharmacotherapy of Cardiovascular Disease

  • 4364 Accesses

Abstract

Non-ST-segment elevation acute coronary syndromes (NSTE ACS) include unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI). The significant morbidity and mortality associated with NSTE ACS have motivated decades of drug development and clinical investigation, with considerable emphasis on the central role of the platelet in the pathophysiology and treatment of these disease processes. This chapter offers a broad overview of the pharmacologic treatment of NSTE ACS, with an emphasis on (1) antiplatelet agents, including low-dose aspirin, second- and third-generation P2Y12 receptor blockers, and glycoprotein IIb/IIIa receptor inhibitors; (2) anticoagulant therapy, including unfractionated heparin, enoxaparin, fondaparinux, and bivalirudin; and (3) other pharmacologic agents, including beta-blockers, nitrates, calcium channel blockers, and statins which are also used in the acute management of NSTE ACS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292.

    Article  PubMed  Google Scholar 

  2. Wright RS, Anderson JL, Adams CD, Bridges CR, Casey Jr DE, Ettinger SM, et al. ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;57(19):e215–367.

    Article  PubMed  Google Scholar 

  3. Lewis Jr HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty 3rd JE, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1983;309(7):396–403.

    Article  PubMed  Google Scholar 

  4. Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985;313(22):1369–75.

    Article  CAS  PubMed  Google Scholar 

  5. Collaborative overview of randomised trials of antiplatelet therapy – I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet trialists’ collaboration. BMJ. 1994;308(6921):81–106.

    Google Scholar 

  6. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2(8607):349–60.

    Google Scholar 

  7. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71–86.

    Article  Google Scholar 

  8. Investigators C-O, Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Eikelboom JW, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363(10):930–42.

    Article  Google Scholar 

  9. von Beckerath N, Taubert D, Pogatsa-Murray G, Schomig E, Kastrati A, Schomig A. Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) trial. Circulation. 2005;112(19):2946–50.

    Google Scholar 

  10. Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G. Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. Circulation. 2005;111(16):2099–106.

    Article  CAS  PubMed  Google Scholar 

  11. Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366(9497):1607–21.

    Article  CAS  PubMed  Google Scholar 

  12. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494–502.

    Article  CAS  PubMed  Google Scholar 

  13. Bavry AA, Lincoff AM. Is clopidogrel cardiovascular medicine’s double-edged sword? Circulation. 2006;113(13):1638–40.

    Article  PubMed  Google Scholar 

  14. Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med. 2009;360(4):354–62.

    Article  CAS  PubMed  Google Scholar 

  15. Collet JP, Hulot JS, Anzaha G, Pena A, Chastre T, Caron C, et al. High doses of clopidogrel to overcome genetic resistance: the randomized crossover CLOVIS-2 (Clopidogrel and Response Variability Investigation Study 2). JACC Cardiovasc Interv. 2011;4(4):392–402.

    Article  PubMed  Google Scholar 

  16. Hulot JS, Collet JP, Cayla G, Silvain J, Allanic F, Bellemain-Appaix A, et al. CYP2C19 but not PON1 genetic variants influence clopidogrel pharmacokinetics, pharmacodynamics, and clinical efficacy in post-myocardial infarction patients. Circ Cardiovasc Interv. 2011;4(5):422–8.

    Article  CAS  PubMed  Google Scholar 

  17. Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010;363(20):1909–17.

    Article  CAS  PubMed  Google Scholar 

  18. Brandt JT, Payne CD, Wiviott SD, Weerakkody G, Farid NA, Small DS, et al. A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation. Am Heart J. 2007;153(1):66, e9–16.

    Article  CAS  PubMed  Google Scholar 

  19. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15.

    Article  CAS  PubMed  Google Scholar 

  20. Roe MT, Armstrong PW, Fox KA, White HD, Prabhakaran D, Goodman SG, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012;367(14):1297–309.

    Article  CAS  PubMed  Google Scholar 

  21. Storey RF, Husted S, Harrington RA, Heptinstall S, Wilcox RG, Peters G, et al. Inhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes. J Am Coll Cardiol. 2007;50(19):1852–6.

    Article  CAS  PubMed  Google Scholar 

  22. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  CAS  PubMed  Google Scholar 

  23. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. The EPIC Investigation. N Eng J Med. 1994;330(14):956–61.

    Google Scholar 

  24. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med. 1997;336(24):1689–96.

    Google Scholar 

  25. Lincoff AM, Tcheng JE, Califf RM, Kereiakes DJ, Kelly TA, Timmis GC, et al. Sustained suppression of ischemic complications of coronary intervention by platelet GP IIb/IIIa blockade with abciximab: one-year outcome in the EPILOG trial. Evaluation in PTCA to improve long-term outcome with abciximab GP IIb/IIIa blockade. Circulation. 1999;99(15):1951–8.

    Article  CAS  PubMed  Google Scholar 

  26. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. N Eng J Med. 1998;338(21):1488–97.

    Google Scholar 

  27. Simoons ML. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial. Lancet. 2001;357(9272):1915–24.

    Article  CAS  PubMed  Google Scholar 

  28. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: receptor suppression using Integrilin therapy. N Eng J Med. 1998;339(7):436–43.

    Google Scholar 

  29. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators. N Eng J Med. 1998;338(21):1498–505.

    Google Scholar 

  30. Heeschen C, Hamm CW, Goldmann B, Deu A, Langenbrink L, White HD. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet receptor inhibition in ischemic syndrome management. Lancet. 1999;354(9192):1757–62.

    Article  CAS  PubMed  Google Scholar 

  31. Roe MT, Moliterno DJ. The EPILOG trial. Abciximab prevents ischemic complications during angioplasty. Evaluation in PTCA to improve long-term outcome with abciximab GP IIb/IIIa blockade. Cleve Clin J Med. 1998;65(5):267–72.

    Article  CAS  PubMed  Google Scholar 

  32. Investigators E. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet. 1998;352(9122):87–92.

    Article  Google Scholar 

  33. Boersma E, Harrington RA, Moliterno DJ, White H, Theroux P, Van de Werf F, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002;359(9302):189–98.

    Article  CAS  PubMed  Google Scholar 

  34. Kastrati A, Mehilli J, Neumann FJ, Dotzer F, ten Berg J, Bollwein H, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA. 2006;295(13):1531–8.

    Article  CAS  PubMed  Google Scholar 

  35. Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M, et al. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N Engl J Med. 2011;365(21):1980–9.

    Article  PubMed  Google Scholar 

  36. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355(21):2203–16.

    Article  CAS  PubMed  Google Scholar 

  37. Giugliano RP, White JA, Bode C, Armstrong PW, Montalescot G, Lewis BS, et al. Early versus delayed, provisional eptifibatide in acute coronary syndromes. N Engl J Med. 2009;360(21):2176–90.

    Article  CAS  PubMed  Google Scholar 

  38. Oler A, Whooley MA, Oler J, Grady D. Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. A meta-analysis. JAMA. 1996;276(10):811–5.

    Article  CAS  PubMed  Google Scholar 

  39. Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319(17):1105–11.

    Article  CAS  PubMed  Google Scholar 

  40. Cohen M, Adams PC, Hawkins L, Bach M, Fuster V. Usefulness of antithrombotic therapy in resting angina pectoris or non-Q-wave myocardial infarction in preventing death and myocardial infarction (a pilot study from the Antithrombotic Therapy in Acute Coronary Syndromes Study Group). Am J Cardiol. 1990;66(19):1287–92.

    Article  CAS  PubMed  Google Scholar 

  41. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. The RISC Group. Lancet. 1990;336(8719):827–30.

    Google Scholar 

  42. Cohen M, Adams PC, Parry G, Xiong J, Chamberlain D, Wieczorek I, et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial. Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Circulation. 1994;89(1):81–8.

    Article  CAS  PubMed  Google Scholar 

  43. Holdright D, Patel D, Cunningham D, Thomas R, Hubbard W, Hendry G, et al. Comparison of the effect of heparin and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina. J Am Coll Cardiol. 1994;24(1):39–45.

    Article  CAS  PubMed  Google Scholar 

  44. Gurfinkel EP, Manos EJ, Mejail RI, Cerda MA, Duronto EA, Garcia CN, et al. Low molecular weight heparin versus regular heparin or aspirin in the treatment of unstable angina and silent ischemia. J Am Coll Cardiol. 1995;26(2):313–8.

    Article  CAS  PubMed  Google Scholar 

  45. Cohen M, Demers C, Gurfinkel EP, Turpie AG, Fromell GJ, Goodman S, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med. 1997;337(7):447–52.

    Article  CAS  PubMed  Google Scholar 

  46. Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D, et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation. 1999;100(15):1593–601.

    Article  CAS  PubMed  Google Scholar 

  47. Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, et al. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;292(1):45–54.

    CAS  PubMed  Google Scholar 

  48. de Lemos JA, Blazing MA, Wiviott SD, Brady WE, White HD, Fox KA, et al. Enoxaparin versus unfractionated heparin in patients treated with tirofiban, aspirin and an early conservative initial management strategy: results from the A phase of the A-to-Z trial. Eur Heart J. 2004;25(19):1688–94.

    Article  PubMed  Google Scholar 

  49. Goodman SG, Cohen M, Bigonzi F, Gurfinkel EP, Radley DR, Le Iouer V, et al. Randomized trial of low molecular weight heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease: one-year results of the ESSENCE Study. Efficacy and safety of subcutaneous enoxaparin in non-Q wave coronary events. J Am Coll Cardiol. 2000;36(3):693–8.

    Article  CAS  PubMed  Google Scholar 

  50. Blazing MA, de Lemos JA, White HD, Fox KA, Verheugt FW, Ardissino D, et al. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. JAMA. 2004;292(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  51. Mahaffey KW, Cohen M, Garg J, Antman E, Kleiman NS, Goodman SG, et al. High-risk patients with acute coronary syndromes treated with low-molecular-weight or unfractionated heparin: outcomes at 6 months and 1 year in the SYNERGY trial. JAMA. 2005;294(20):2594–600.

    Article  CAS  PubMed  Google Scholar 

  52. Silvain J, Beygui F, Barthelemy O, Pollack Jr C, Cohen M, Zeymer U, et al. Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. BMJ. 2012;344:e553.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes I, Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006;354(14):1464–76.

    Article  Google Scholar 

  54. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295(13):1519–30.

    Article  CAS  PubMed  Google Scholar 

  55. Mukherjee D, Fang J, Chetcuti S, Moscucci M, Kline-Rogers E, Eagle KA. Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation. 2004;109(6):745–9.

    Article  PubMed  Google Scholar 

  56. Ellis K, Tcheng JE, Sapp S, Topol EJ, Lincoff AM. Mortality benefit of beta blockade in patients with acute coronary syndromes undergoing coronary intervention: pooled results from the Epic, Epilog, Epistent, Capture and Rapport Trials. J Interv Cardiol. 2003;16(4):299–305.

    Article  PubMed  Google Scholar 

  57. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357(9266):1385–90.

    Article  CAS  PubMed  Google Scholar 

  58. Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma. J Am Coll Cardiol. 2001;37(7):1950–6.

    Article  CAS  PubMed  Google Scholar 

  59. Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT). Am J Cardiol. 1987;60(2):18A–25.

    Article  CAS  PubMed  Google Scholar 

  60. Held PH, Yusuf S, Furberg CD. Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. BMJ. 1989;299(6709):1187–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Hansen JF, Hagerup L, Sigurd B, Pedersen F, Mellemgaard K, Pedersen-Bjergaard O, et al. Cardiac event rates after acute myocardial infarction in patients treated with verapamil and trandolapril versus trandolapril alone. Danish Verapamil Infarction Trial (DAVIT) Study Group. Am J Cardiol. 1997;79(6):738–41.

    Article  CAS  PubMed  Google Scholar 

  62. Gibson RS, Boden WE, Theroux P, Strauss HD, Pratt CM, Gheorghiade M, et al. Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. Results of a double-blind, randomized, multicenter trial. N Engl J Med. 1986;315(7):423–9.

    Article  CAS  PubMed  Google Scholar 

  63. Yusuf S, Pepine CJ, Garces C, Pouleur H, Salem D, Kostis J, et al. Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions. Lancet. 1992;340(8829):1173–8.

    Article  CAS  PubMed  Google Scholar 

  64. Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. ACE Inhibitor Myocardial Infarction Collaborative Group. Circulation. 1998;97(22):2202–12.

    Google Scholar 

  65. Gustafsson I, Torp-Pedersen C, Kober L, Gustafsson F, Hildebrandt P. Effect of the angiotensin-converting enzyme inhibitor trandolapril on mortality and morbidity in diabetic patients with left ventricular dysfunction after acute myocardial infarction. Trace Study Group. J Am Coll Cardiol. 1999;34(1):83–9.

    Article  CAS  PubMed  Google Scholar 

  66. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349(20):1893–906.

    Article  CAS  PubMed  Google Scholar 

  67. Davignon J. Beneficial cardiovascular pleiotropic effects of statins. Circulation. 2004;109(23 Suppl 1):III39–43.

    PubMed  Google Scholar 

  68. Hulten E, Jackson JL, Douglas K, George S, Villines TC. The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166(17):1814–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave., Mail Code J2-3, Cleveland, OH, 44195, USA

    Daniel M. Shivapour MD

  2. Department of Cardiovascular Medicine, Clinic Coordinating Center for Clinical Research (C5Research), Cleveland Clinic, 9500 Euclid Ave., Mail Code J2-3, Cleveland, OH, 44195, USA

    A. Michael Lincoff MD

Authors
  1. Daniel M. Shivapour MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Michael Lincoff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Michael Lincoff MD .

Editor information

Editors and Affiliations

  1. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Gowraganahalli Jagadeesh

  2. Pharmacology Unit, AIMST University, Bedong, Malaysia

    Pitchai Balakumar

  3. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Khin Maung-U

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Shivapour, D.M., Lincoff, A.M. (2015). Therapy for Acute Coronary Syndrome and Unstable Angina. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15961-4_23

  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-15960-7

  • Online ISBN: 978-3-319-15961-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation