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. 2001 Feb;85(2):133–142. doi: 10.1136/heart.85.2.133

Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation

PMCID: PMC1729608  PMID: 11156660

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Figure 1  .

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Summary flow chart for management of patients with suspected acute coronary syndromes without ECG ST segment elevation.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen K., Eriksson P., Dellborg M. Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease. Eur Heart J. 1997 May;18(5):780–788. doi: 10.1093/oxfordjournals.eurheartj.a015343. [DOI] [PubMed] [Google Scholar]
  2. Anderson H. V., Cannon C. P., Stone P. H., Williams D. O., McCabe C. H., Knatterud G. L., Thompson B., Willerson J. T., Braunwald E. One-year results of the Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial. A randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol. 1995 Dec;26(7):1643–1650. doi: 10.1016/0735-1097(95)00404-1. [DOI] [PubMed] [Google Scholar]
  3. Antman E. M., Cohen M., Bernink P. J., McCabe C. H., Horacek T., Papuchis G., Mautner B., Corbalan R., Radley D., Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000 Aug 16;284(7):835–842. doi: 10.1001/jama.284.7.835. [DOI] [PubMed] [Google Scholar]
  4. Antman E. M., Cohen M., Radley D., McCabe C., Rush J., Premmereur J., Braunwald E. Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction. TIMI 11B-ESSENCE meta-analysis. Circulation. 1999 Oct 12;100(15):1602–1608. doi: 10.1161/01.cir.100.15.1602. [DOI] [PubMed] [Google Scholar]
  5. Antman E. M., McCabe C. H., Gurfinkel E. P., Turpie A. G., Bernink P. J., Salein D., Bayes De Luna A., Fox K., Lablanche J. M., Radley D. 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 Oct 12;100(15):1593–1601. doi: 10.1161/01.cir.100.15.1593. [DOI] [PubMed] [Google Scholar]
  6. Antman E. M., Tanasijevic M. J., Thompson B., Schactman M., McCabe C. H., Cannon C. P., Fischer G. A., Fung A. Y., Thompson C., Wybenga D. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996 Oct 31;335(18):1342–1349. doi: 10.1056/NEJM199610313351802. [DOI] [PubMed] [Google Scholar]
  7. Anzai T., Yoshikawa T., Asakura Y., Abe S., Akaishi M., Mitamura H., Handa S., Ogawa S. Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction. J Am Coll Cardiol. 1995 Aug;26(2):319–327. doi: 10.1016/0735-1097(95)80002-x. [DOI] [PubMed] [Google Scholar]
  8. Barakat K., Kennon S., Wilkinson P., Ranjadayalan K., Timmis A. D. Selection bias in the management of unstable angina. J R Coll Physicians Lond. 2000 Mar-Apr;34(2):179–184. [PMC free article] [PubMed] [Google Scholar]
  9. Betriu A., Heras M., Cohen M., Fuster V. Unstable angina: outcome according to clinical presentation. J Am Coll Cardiol. 1992 Jun;19(7):1659–1663. doi: 10.1016/0735-1097(92)90633-x. [DOI] [PubMed] [Google Scholar]
  10. Boden W. E., O'Rourke R. A., Crawford M. H., Blaustein A. S., Deedwania P. C., Zoble R. G., Wexler L. F., Kleiger R. E., Pepine C. J., Ferry D. R. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998 Jun 18;338(25):1785–1792. doi: 10.1056/NEJM199806183382501. [DOI] [PubMed] [Google Scholar]
  11. Bodenheimer M. M., Wackers F. J., Schwartz R. G., Brown M. Prognostic significance of a fixed thallium defect one to six months after onset of acute myocardial infarction or unstable angina. Multicenter Myocardial Ischemia Research Group. Am J Cardiol. 1994 Dec 15;74(12):1196–1200. doi: 10.1016/0002-9149(94)90547-9. [DOI] [PubMed] [Google Scholar]
  12. Boersma E., Akkerhuis K. M., Théroux P., Califf R. M., Topol E. J., Simoons M. L. Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation. 1999 Nov 16;100(20):2045–2048. doi: 10.1161/01.cir.100.20.2045. [DOI] [PubMed] [Google Scholar]
  13. Borzak S., Verter J., Bajwa H. S., Lesch M. Thrombolytic therapy for unstable angina. Clin Cardiol. 1993 Sep;16(9):637–642. doi: 10.1002/clc.4960160903. [DOI] [PubMed] [Google Scholar]
  14. Braunwald E. Unstable angina. A classification. Circulation. 1989 Aug;80(2):410–414. doi: 10.1161/01.cir.80.2.410. [DOI] [PubMed] [Google Scholar]
  15. Bridgewater B. Death on the waiting list for cardiac surgery. Heart. 1999 Jun;81(6):564–564. doi: 10.1136/hrt.81.6.564. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Cohen M., Demers C., Gurfinkel E. P., Turpie A. G., Fromell G. J., Goodman S., Langer A., Califf R. M., Fox K. A., Premmereur J. 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 Aug 14;337(7):447–452. doi: 10.1056/NEJM199708143370702. [DOI] [PubMed] [Google Scholar]
  17. Curfman G. D., Heinsimer J. A., Lozner E. C., Fung H. L. Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial. Circulation. 1983 Feb;67(2):276–282. doi: 10.1161/01.cir.67.2.276. [DOI] [PubMed] [Google Scholar]
  18. Davie A. P., Caesar D., Caruana L., Clegg G., Spiller J., Capewell S., Starkey I. R., Shaw T. R., McMurray J. J. Outcome from a rapid-assessment chest pain clinic. QJM. 1998 May;91(5):339–343. doi: 10.1093/qjmed/91.5.339. [DOI] [PubMed] [Google Scholar]
  19. Davies M. J., Thomas A. C. Plaque fissuring--the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J. 1985 Apr;53(4):363–373. doi: 10.1136/hrt.53.4.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. DePace N. L., Herling I. M., Kotler M. N., Hakki A. H., Spielman S. R., Segal B. L. Intravenous nitroglycerin for rest angina. Potential pathophysiologic mechanisms of action. Arch Intern Med. 1982 Oct;142(10):1806–1809. [PubMed] [Google Scholar]
  21. Dellborg M., Gustafsson G., Swedberg K. Buccal versus intravenous nitroglycerin in unstable angina pectoris. Eur J Clin Pharmacol. 1991;41(1):5–9. doi: 10.1007/BF00280098. [DOI] [PubMed] [Google Scholar]
  22. Eagle K. A., Guyton R. A., Davidoff R., Ewy G. A., Fonger J., Gardner T. J., Gott J. P., Herrmann H. C., Marlow R. A., Nugent W. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations : A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation. 1999 Sep 28;100(13):1464–1480. doi: 10.1161/01.cir.100.13.1464. [DOI] [PubMed] [Google Scholar]
  23. Edwards F. H., Clark R. E., Schwartz M. Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. Ann Thorac Surg. 1994 Jan;57(1):12–19. doi: 10.1016/0003-4975(94)90358-1. [DOI] [PubMed] [Google Scholar]
  24. Eikelboom J. W., Anand S. S., Malmberg K., Weitz J. I., Ginsberg J. S., Yusuf S. Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet. 2000 Jun 3;355(9219):1936–1942. doi: 10.1016/S0140-6736(00)02324-2. [DOI] [PubMed] [Google Scholar]
  25. Farkouh M. E., Smars P. A., Reeder G. S., Zinsmeister A. R., Evans R. W., Meloy T. D., Kopecky S. L., Allen M., Allison T. G., Gibbons R. J. A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med. 1998 Dec 24;339(26):1882–1888. doi: 10.1056/NEJM199812243392603. [DOI] [PubMed] [Google Scholar]
  26. Fuster V., Badimon L., Cohen M., Ambrose J. A., Badimon J. J., Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation. 1988 Jun;77(6):1213–1220. doi: 10.1161/01.cir.77.6.1213. [DOI] [PubMed] [Google Scholar]
  27. Gaspoz J. M., Lee T. H., Weinstein M. C., Cook E. F., Goldman P., Komaroff A. L., Goldman L. Cost-effectiveness of a new short-stay unit to "rule out" acute myocardial infarction in low risk patients. J Am Coll Cardiol. 1994 Nov 1;24(5):1249–1259. doi: 10.1016/0735-1097(94)90106-6. [DOI] [PubMed] [Google Scholar]
  28. Gerstenblith G., Ouyang P., Achuff S. C., Bulkley B. H., Becker L. C., Mellits E. D., Baughman K. L., Weiss J. L., Flaherty J. T., Kallman C. H. Nifedipine in unstable angina: a double-blind, randomized trial. N Engl J Med. 1982 Apr 15;306(15):885–889. doi: 10.1056/NEJM198204153061501. [DOI] [PubMed] [Google Scholar]
  29. Gibson R. S., Boden W. E., Theroux P., Strauss H. D., Pratt C. M., Gheorghiade M., Capone R. J., Crawford M. H., Schlant R. C., Kleiger R. E. Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. Results of a double-blind, randomized, multicenter trial. N Engl J Med. 1986 Aug 14;315(7):423–429. doi: 10.1056/NEJM198608143150704. [DOI] [PubMed] [Google Scholar]
  30. Goldstein R. E., Boccuzzi S. J., Cruess D., Nattel S. Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. Circulation. 1991 Jan;83(1):52–60. doi: 10.1161/01.cir.83.1.52. [DOI] [PubMed] [Google Scholar]
  31. Gomez M. A., Anderson J. L., Karagounis L. A., Muhlestein J. B., Mooers F. B. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol. 1996 Jul;28(1):25–33. doi: 10.1016/0735-1097(96)00093-9. [DOI] [PubMed] [Google Scholar]
  32. Goodacre S. W. Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature. J Accid Emerg Med. 2000 Jan;17(1):1–6. doi: 10.1136/emj.17.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Gottlieb S. O., Weisfeldt M. L., Ouyang P., Achuff S. C., Baughman K. L., Traill T. A., Brinker J. A., Shapiro E. P., Chandra N. C., Mellits E. D. Effect of the addition of propranolol to therapy with nifedipine for unstable angina pectoris: a randomized, double-blind, placebo-controlled trial. Circulation. 1986 Feb;73(2):331–337. doi: 10.1161/01.cir.73.2.331. [DOI] [PubMed] [Google Scholar]
  34. Goy J. J. Contemporary approach to management of unstable angina. Lancet. 1999 Aug 28;354(9180):694–695. doi: 10.1016/S0140-6736(99)00264-0. [DOI] [PubMed] [Google Scholar]
  35. Grover F. L., Hammermeister K. E., Burchfiel C. Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. Ann Thorac Surg. 1990 Jul;50(1):12–28. doi: 10.1016/0003-4975(90)90073-f. [DOI] [PubMed] [Google Scholar]
  36. Hamm C. W., Goldmann B. U., Heeschen C., Kreymann G., Berger J., Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med. 1997 Dec 4;337(23):1648–1653. doi: 10.1056/NEJM199712043372302. [DOI] [PubMed] [Google Scholar]
  37. Hamm C. W., Heeschen C., Goldmann B., Vahanian A., Adgey J., Miguel C. M., Rutsch W., Berger J., Kootstra J., Simoons M. L. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) Study Investigators. N Engl J Med. 1999 May 27;340(21):1623–1629. doi: 10.1056/NEJM199905273402103. [DOI] [PubMed] [Google Scholar]
  38. Heeschen C., Hamm C. W., Goldmann B., Deu A., Langenbrink L., White H. D. 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 Nov 20;354(9192):1757–1762. doi: 10.1016/s0140-6736(99)10285-x. [DOI] [PubMed] [Google Scholar]
  39. Heller G. V., Stowers S. A., Hendel R. C., Herman S. D., Daher E., Ahlberg A. W., Baron J. M., Mendes de Leon C. F., Rizzo J. A., Wackers F. J. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. J Am Coll Cardiol. 1998 Apr;31(5):1011–1017. doi: 10.1016/s0735-1097(98)00057-6. [DOI] [PubMed] [Google Scholar]
  40. Hillis G. S., Zhao N., Taggart P., Dalsey W. C., Mangione A. Utility of cardiac troponin I, creatine kinase-MB(mass), myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain. Heart. 1999 Nov;82(5):614–620. doi: 10.1136/hrt.82.5.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Holmvang L., Andersen K., Dellborg M., Clemmensen P., Wagner G., Grande P., Abrahamsson P. Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease. Am J Cardiol. 1999 Mar 1;83(5):667–674. doi: 10.1016/s0002-9149(98)00964-3. [DOI] [PubMed] [Google Scholar]
  42. Kaplan K., Davison R., Parker M., Przybylek J., Teagarden J. R., Lesch M. Intravenous nitroglycerin for the treatment of angina at rest unresponsive to standard nitrate therapy. Am J Cardiol. 1983 Mar 1;51(5):694–698. doi: 10.1016/s0002-9149(83)80117-9. [DOI] [PubMed] [Google Scholar]
  43. Keavney B., Haider Y. M., McCance A. J., Skehan J. D. Normal coronary angiograms: financial victory from the brink of clinical defeat? Heart. 1996 Jun;75(6):623–625. doi: 10.1136/hrt.75.6.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Kerns J. R., Shaub T. F., Fontanarosa P. B. Emergency cardiac stress testing in the evaluation of emergency department patients with atypical chest pain. Ann Emerg Med. 1993 May;22(5):794–798. doi: 10.1016/s0196-0644(05)80793-0. [DOI] [PubMed] [Google Scholar]
  45. Klein W., Buchwald A., Hillis S. E., Monrad S., Sanz G., Turpie A. G., van der Meer J., Olaisson E., Undeland S., Ludwig K. Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC) Circulation. 1997 Jul 1;96(1):61–68. doi: 10.1161/01.cir.96.1.61. [DOI] [PubMed] [Google Scholar]
  46. Kong D. F., Califf R. M., Miller D. P., Moliterno D. J., White H. D., Harrington R. A., Tcheng J. E., Lincoff A. M., Hasselblad V., Topol E. J. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation. 1998 Dec 22;98(25):2829–2835. doi: 10.1161/01.cir.98.25.2829. [DOI] [PubMed] [Google Scholar]
  47. Lee H. S., Cross S. J., Rawles J. M., Jennings K. P. Patients with suspected myocardial infarction who present with ST depression. Lancet. 1993 Nov 13;342(8881):1204–1207. doi: 10.1016/0140-6736(93)92186-w. [DOI] [PubMed] [Google Scholar]
  48. Lin S. S., Lauer M. S., Marwick T. H. Risk stratification of patients with medically treated unstable angina using exercise echocardiography. Am J Cardiol. 1998 Sep 15;82(6):720–724. doi: 10.1016/s0002-9149(98)00462-7. [DOI] [PubMed] [Google Scholar]
  49. Lindahl B., Andrén B., Ohlsson J., Venge P., Wallentin L. Risk stratification in unstable coronary artery disease. Additive value of troponin T determinations and pre-discharge exercise tests. FRISK Study Group. Eur Heart J. 1997 May;18(5):762–770. doi: 10.1093/oxfordjournals.eurheartj.a015341. [DOI] [PubMed] [Google Scholar]
  50. Liuzzo G., Biasucci L. M., Gallimore J. R., Grillo R. L., Rebuzzi A. G., Pepys M. B., Maseri A. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994 Aug 18;331(7):417–424. doi: 10.1056/NEJM199408183310701. [DOI] [PubMed] [Google Scholar]
  51. Luchi R. J., Scott S. M., Deupree R. H. Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1987 Apr 16;316(16):977–984. doi: 10.1056/NEJM198704163161603. [DOI] [PubMed] [Google Scholar]
  52. Lüscher M. S., Thygesen K., Ravkilde J., Heickendorff L. Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease. TRIM Study Group. Thrombin Inhibition in Myocardial ischemia. Circulation. 1997 Oct 21;96(8):2578–2585. doi: 10.1161/01.cir.96.8.2578. [DOI] [PubMed] [Google Scholar]
  53. Magovern J. A., Sakert T., Magovern G. J., Benckart D. H., Burkholder J. A., Liebler G. A., Magovern G. J., Sr A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996 Nov 1;28(5):1147–1153. doi: 10.1016/S0735-1097(96)00310-5. [DOI] [PubMed] [Google Scholar]
  54. Malinow M. R. Regression of atherosclerosis in humans: fact or myth? Circulation. 1981 Jul;64(1):1–3. doi: 10.1161/01.cir.64.1.1. [DOI] [PubMed] [Google Scholar]
  55. Markiewicz W. Management of unstable coronary-artery disease. Lancet. 2000 Feb 12;355(9203):572–574. doi: 10.1016/S0140-6736(05)73219-0. [DOI] [PubMed] [Google Scholar]
  56. McCormick J. R., Schick E. C., Jr, McCabe C. H., Kronmal R. A., Ryan T. J. Determinants of operative mortality and long-term survival in patients with unstable angina. The CASS experience. J Thorac Cardiovasc Surg. 1985 May;89(5):683–688. [PubMed] [Google Scholar]
  57. McCullough P. A., O'Neill W. W., Graham M., Stomel R. J., Rogers F., David S., Farhat A., Kazlauskaite R., Al-Zagoum M., Grines C. L. A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Results of the medicine versus angiography in thrombolytic exclusion (MATE) trial. J Am Coll Cardiol. 1998 Sep;32(3):596–605. doi: 10.1016/s0735-1097(98)00284-8. [DOI] [PubMed] [Google Scholar]
  58. Mikolich J. R., Nicoloff N. B., Robinson P. H., Logue R. B. Relief of refractory angina with continuous intravenous infusion of nitroglycerin. Chest. 1980 Mar;77(3):375–379. doi: 10.1378/chest.77.3.375. [DOI] [PubMed] [Google Scholar]
  59. Miller D. D., Stratmann H. G., Shaw L., Tamesis B. R., Wittry M. D., Younis L. T., Chaitman B. R. Dipyridamole technetium 99m sestamibi myocardial tomography as an independent predictor of cardiac event-free survival after acute ischemic events. J Nucl Cardiol. 1994 Jan-Feb;1(1):72–82. doi: 10.1007/BF02940014. [DOI] [PubMed] [Google Scholar]
  60. Moreno R., López de Sá E., López-Sendón J. L., Ortega A., Fernández M. J., Fernández-Bobadilla J., Delcán J. L. Prognosis of medically stabilized unstable angina pectoris with a negative exercise test. Am J Cardiol. 1998 Sep 1;82(5):662-5, A6. doi: 10.1016/s0002-9149(98)00411-1. [DOI] [PubMed] [Google Scholar]
  61. Muller J. E., Turi Z. G., Pearle D. L., Schneider J. F., Serfas D. H., Morrison J., Stone P. H., Rude R. E., Rosner B., Sobel B. E. Nifedipine and conventional therapy for unstable angina pectoris: a randomized, double-blind comparison. Circulation. 1984 Apr;69(4):728–739. doi: 10.1161/01.cir.69.4.728. [DOI] [PubMed] [Google Scholar]
  62. Newby D. E., Fox K. A., Flint L. L., Boon N. A. A 'same day' direct-access chest pain clinic: improved management and reduced hospitalization. QJM. 1998 May;91(5):333–337. doi: 10.1093/qjmed/91.5.333. [DOI] [PubMed] [Google Scholar]
  63. Nyman I., Areskog M., Areskog N. H., Swahn E., Wallentin L. Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease. The RISC Study Group. J Intern Med. 1993 Sep;234(3):293–301. doi: 10.1111/j.1365-2796.1993.tb00746.x. [DOI] [PubMed] [Google Scholar]
  64. Ohman E. M., Armstrong P. W., Christenson R. H., Granger C. B., Katus H. A., Hamm C. W., O'Hanesian M. A., Wagner G. S., Kleiman N. S., Harrell F. E., Jr Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med. 1996 Oct 31;335(18):1333–1341. doi: 10.1056/NEJM199610313351801. [DOI] [PubMed] [Google Scholar]
  65. Olatidoye A. G., Wu A. H., Feng Y. J., Waters D. Prognostic role of troponin T versus troponin I in unstable angina pectoris for cardiac events with meta-analysis comparing published studies. Am J Cardiol. 1998 Jun 15;81(12):1405–1410. doi: 10.1016/s0002-9149(98)00200-8. [DOI] [PubMed] [Google Scholar]
  66. Oler A., Whooley M. A., 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 Sep 11;276(10):811–815. [PubMed] [Google Scholar]
  67. Parisi A. F., Khuri S., Deupree R. H., Sharma G. V., Scott S. M., Luchi R. J. Medical compared with surgical management of unstable angina. 5-year mortality and morbidity in the Veterans Administration Study. Circulation. 1989 Nov;80(5):1176–1189. doi: 10.1161/01.cir.80.5.1176. [DOI] [PubMed] [Google Scholar]
  68. Parsonnet V., Dean D., Bernstein A. D. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989 Jun;79(6 Pt 2):I3–12. [PubMed] [Google Scholar]
  69. Patel D. J., Holdright D. R., Knight C. J., Mulcahy D., Thakrar B., Wright C., Sparrow J., Wicks M., Hubbard W., Thomas R. Early continuous ST segment monitoring in unstable angina: prognostic value additional to the clinical characteristics and the admission electrocardiogram. Heart. 1996 Mar;75(3):222–228. doi: 10.1136/hrt.75.3.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Patel D. J., Knight C. J., Holdright D. R., Mulcahy D., Clarke D., Wright C., Purcell H., Fox K. M. Long-term prognosis in unstable angina. The importance of early risk stratification using continuous ST segment monitoring. Eur Heart J. 1998 Feb;19(2):240–249. doi: 10.1053/euhj.1997.0586. [DOI] [PubMed] [Google Scholar]
  71. Patel D. J., Purcell H. J., Fox K. M. Cardioprotection by opening of the K(ATP) channel in unstable angina. Is this a clinical manifestation of myocardial preconditioning? Results of a randomized study with nicorandil. CESAR 2 investigation. Clinical European studies in angina and revascularization. Eur Heart J. 1999 Jan;20(1):51–57. doi: 10.1053/euhj.1998.1354. [DOI] [PubMed] [Google Scholar]
  72. Pavin D., Delonca J., Siegenthaler M., Doat M., Rutishauser W., Righetti A. Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented by angiography. Eur Heart J. 1997 Jan;18(1):69–77. doi: 10.1093/oxfordjournals.eurheartj.a015120. [DOI] [PubMed] [Google Scholar]
  73. Pocock S. J., Henderson R. A., Rickards A. F., Hampton J. R., King S. B., 3rd, Hamm C. W., Puel J., Hueb W., Goy J. J., Rodriguez A. Meta-analysis of randomised trials comparing coronary angioplasty with bypass surgery. Lancet. 1995 Nov 4;346(8984):1184–1189. doi: 10.1016/s0140-6736(95)92897-9. [DOI] [PubMed] [Google Scholar]
  74. Ramsay L. E., Williams B., Johnston G. D., MacGregor G. A., Poston L., Potter J. F., Poulter N. R., Russell G. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ. 1999 Sep 4;319(7210):630–635. doi: 10.1136/bmj.319.7210.630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Ramsay L., Williams B., Johnston G., MacGregor G., Poston L., Potter J., Poulter N., Russell G. Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypertens. 1999 Sep;13(9):569–592. doi: 10.1038/sj.jhh.1000917. [DOI] [PubMed] [Google Scholar]
  76. Rebuzzi A. G., Quaranta G., Liuzzo G., Caligiuri G., Lanza G. A., Gallimore J. R., Grillo R. L., Cianflone D., Biasucci L. M., Maseri A. Incremental prognostic value of serum levels of troponin T and C-reactive protein on admission in patients with unstable angina pectoris. Am J Cardiol. 1998 Sep 15;82(6):715–719. doi: 10.1016/s0002-9149(98)00458-5. [DOI] [PubMed] [Google Scholar]
  77. Roberts R. R., Zalenski R. J., Mensah E. K., Rydman R. J., Ciavarella G., Gussow L., Das K., Kampe L. M., Dickover B., McDermott M. F. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA. 1997 Nov 26;278(20):1670–1676. [PubMed] [Google Scholar]
  78. Roubin G. S., Harris P. J., Eckhardt I., Hensley W., Kelly D. T. Intravenous nitroglycerine in refractory unstable angina pectoris. Aust N Z J Med. 1982 Dec;12(6):598–602. doi: 10.1111/j.1445-5994.1982.tb02645.x. [DOI] [PubMed] [Google Scholar]
  79. Savonitto S., Ardissino D., Granger C. B., Morando G., Prando M. D., Mafrici A., Cavallini C., Melandri G., Thompson T. D., Vahanian A. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA. 1999 Feb 24;281(8):707–713. doi: 10.1001/jama.281.8.707. [DOI] [PubMed] [Google Scholar]
  80. Scanlon P. J., Faxon D. P., Audet A. M., Carabello B., Dehmer G. J., Eagle K. A., Legako R. D., Leon D. F., Murray J. A., Nissen S. E. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999 May;33(6):1756–1824. doi: 10.1016/s0735-1097(99)00126-6. [DOI] [PubMed] [Google Scholar]
  81. Scott S. M., Luchi R. J., Deupree R. H. Veterans Administration Cooperative Study for treatment of patients with unstable angina. Results in patients with abnormal left ventricular function. Circulation. 1988 Sep;78(3 Pt 2):I113–I121. [PubMed] [Google Scholar]
  82. Seddon M. E., French J. K., Amos D. J., Ramanathan K., McLaughlin S. C., White H. D. Waiting times and prioritization for coronary artery bypass surgery in New Zealand. Heart. 1999 Jun;81(6):586–592. doi: 10.1136/hrt.81.6.586. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Shah P. K. New insights into the pathogenesis and prevention of acute coronary syndromes. Am J Cardiol. 1997 Jun 26;79(12B):17–23. doi: 10.1016/s0002-9149(97)00381-0. [DOI] [PubMed] [Google Scholar]
  84. Sim I., Gupta M., McDonald K., Bourassa M. G., Hlatky M. A. A meta-analysis of randomized trials comparing coronary artery bypass grafting with percutaneous transluminal coronary angioplasty in multivessel coronary artery disease. Am J Cardiol. 1995 Nov 15;76(14):1025–1029. doi: 10.1016/s0002-9149(99)80289-6. [DOI] [PubMed] [Google Scholar]
  85. Solymoss B. C., Bourassa M. G., Wesolowska E., Dryda I., Théroux P., Mondor L., Perrault D., Gilfix B. M. The role of cardiac troponin T and other new biochemical markers in evaluation and risk stratification of patients with acute chest pain syndromes. Clin Cardiol. 1997 Nov;20(11):934–942. doi: 10.1002/clc.4960201107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  86. Stratmann H. G., Tamesis B. R., Younis L. T., Wittry M. D., Amato M., Miller D. D. Prognostic value of predischarge dipyridamole technetium 99m sestamibi myocardial tomography in medically treated patients with unstable angina. Am Heart J. 1995 Oct;130(4):734–740. doi: 10.1016/0002-8703(95)90071-3. [DOI] [PubMed] [Google Scholar]
  87. Stratmann H. G., Younis L. T., Wittry M. D., Amato M., Miller D. D. Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris. Am J Cardiol. 1995 Aug 1;76(4):236–240. doi: 10.1016/s0002-9149(99)80072-1. [DOI] [PubMed] [Google Scholar]
  88. Stubbs P., Collinson P., Moseley D., Greenwood T., Noble M. Prospective study of the role of cardiac troponin T in patients admitted with unstable angina. BMJ. 1996 Aug 3;313(7052):262–264. doi: 10.1136/bmj.313.7052.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. Suttorp M. J., Kingma J. H., Vos J., Koomen E. M., Tijssen J. G., Vermeulen F. E., Ascoop C. A., Ernst J. M. Determinants for early mortality in patients awaiting coronary artery bypass graft surgery: a case-control study. Eur Heart J. 1992 Feb;13(2):238–242. doi: 10.1093/oxfordjournals.eurheartj.a060153. [DOI] [PubMed] [Google Scholar]
  90. Théroux P., Ouimet H., McCans J., Latour J. G., Joly P., Lévy G., Pelletier E., Juneau M., Stasiak J., deGuise P. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988 Oct 27;319(17):1105–1111. doi: 10.1056/NEJM198810273191701. [DOI] [PubMed] [Google Scholar]
  91. Théroux P., Waters D., Qiu S., McCans J., de Guise P., Juneau M. Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation. 1993 Nov;88(5 Pt 1):2045–2048. doi: 10.1161/01.cir.88.5.2045. [DOI] [PubMed] [Google Scholar]
  92. Tu J. V., Jaglal S. B., Naylor C. D. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995 Feb 1;91(3):677–684. doi: 10.1161/01.cir.91.3.677. [DOI] [PubMed] [Google Scholar]
  93. Tu J. V., Sykora K., Naylor C. D. Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario. J Am Coll Cardiol. 1997 Nov 1;30(5):1317–1323. doi: 10.1016/s0735-1097(97)00295-7. [DOI] [PubMed] [Google Scholar]
  94. Unstable angina pectoris: National Cooperative Study Group to Compare Surgical and Medical Therapy. Am J Cardiol. 1978 Nov;42(5):839–848. doi: 10.1016/0002-9149(78)90105-4. [DOI] [PubMed] [Google Scholar]
  95. Wynne-Jones K., Jackson M., Grotte G., Bridgewater B. Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England. The North West Regional Cardiac Surgery Audit Steering Group. Heart. 2000 Jul;84(1):71–78. doi: 10.1136/heart.84.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  96. Yusuf S., Flather M., Pogue J., Hunt D., Varigos J., Piegas L., Avezum A., Anderson J., Keltai M., Budaj A. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation. OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators. Lancet. 1998 Aug 15;352(9127):507–514. doi: 10.1016/s0140-6736(97)11162-x. [DOI] [PubMed] [Google Scholar]
  97. Yusuf S. Verapamil following uncomplicated myocardial infarction: promising, but not proven. Am J Cardiol. 1996 Feb 15;77(5):421–422. doi: 10.1016/s0002-9149(97)89376-9. [DOI] [PubMed] [Google Scholar]
  98. Yusuf S., Wittes J., Friedman L. Overview of results of randomized clinical trials in heart disease. II. Unstable angina, heart failure, primary prevention with aspirin, and risk factor modification. JAMA. 1988 Oct 21;260(15):2259–2263. [PubMed] [Google Scholar]
  99. van Miltenburg-van Zijl A. J., Simoons M. L., Veerhoek R. J., Bossuyt P. M. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris. J Am Coll Cardiol. 1995 May;25(6):1286–1292. doi: 10.1016/0735-1097(95)00009-S. [DOI] [PubMed] [Google Scholar]
  100. van der Giessen W. J., Mooi W., Rutteman A. M., van Vliet H. H., Slager C. J., Verdouw P. D. A new model for coronary thrombosis in the pig: preliminary results with thrombolysis. Eur Heart J. 1983 May;4 (Suppl 100):69–76. doi: 10.1093/eurheartj/4.suppl_c.69. [DOI] [PubMed] [Google Scholar]

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