Abstract
Unstable coronary artery disease continues to pose a major challenge to clinicians. The advent of new therapies, such as percutaneous transluminal coronary angioplasty, low‐molecular‐weight heparins, and glycoprotein IIb/IIIa inhibitors, provides new management options for this indication but also raises new questions with regard to optimal management. Prospective randomized trials with well‐defined, long‐term outcome measures and a means of identifying which patients will derive most benefit from each treatment, together with a means of rapid and clear dissemination of study results and implications, are required in order to advance the management of unstable coronary artery disease.
Keywords: unstable coronary artery disease, antithrombotic, revascularization, clinical trial, heparin
Full Text
The Full Text of this article is available as a PDF (342.7 KB).
References
- 1. Van Belle E, Lablanche J‐M, Bauters C, Renaud N, McFadden EP, Bertrand ME: Coronary angioscopic findings in the infarct‐related vessel within 1 month of acute myocardial infarction—natural history and effect of thrombolysis. Circulation 1997; 97: 26–33 [DOI] [PubMed] [Google Scholar]
- 2. Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chesler E, DeMots H: Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 1983; 309: 396–403 [DOI] [PubMed] [Google Scholar]
- 3. Théroux P, Ouimet H, McCans J, Latour JG, Joly P Lévy G, Pelletier E, Juneau M, Stasiak J de Guise P, Pelletier GB, Rinzler D, Waters DD: Aspirin, heparin or both to treat unstable angina. N Engl J Med 1988; 319: 1105–1111 [DOI] [PubMed] [Google Scholar]
- 4. The RISC Group : Risk of myocardial infarction and death during treatment with low‐dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827–830 [PubMed] [Google Scholar]
- 5. Klein W, Buchwald A, Hillis SE, Monrad S, Sanz G, Turpie GG van der Meer J, Olaisson E, Undeland S, Ludwig K, for the Fragmin in Unstable Coronary Artery Disease (FRIC) Investigators : Comparison of low‐molecular‐weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Circulation 1997; 96: 61–68 [DOI] [PubMed] [Google Scholar]
- 6. Cohen M, Demers C, Gurfinkel EP, Turpie GG, Fromell GJ, Goodman S, Langer A, Califf RM, Fox KAA, Premmereur J, Bigonzie F for the Efficacy and Safety of Subcutaneous Enoxaparin in Non‐Q‐Wave Coronary Events (ESSENCE) Study Group : A comparison of low‐molecular‐weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997; 337: 447–452 [DOI] [PubMed] [Google Scholar]
- 7. Wallentin L, Husted S, Kontny F, Swahn E for the FRISC II Study Group : Long‐term low‐molecular‐weight heparin (Fragmin) and/or early revascularization during instability in coronary artery disease (the FRISC II Study). Am J Cardiol 1997; 80 (5A): 61E–63E [DOI] [PubMed] [Google Scholar]
- 8. Fragmin during Instability in Coronary Artery Disease (FRISC) Study Group : Low‐molecular‐weight heparin during instability in coronary artery disease. Lancet 1996; 347: 561–568 [PubMed] [Google Scholar]
- 9. Anand SS, Yusuf S, Pogue J, Weitz JI, Flather M: Long‐term oral anticoagulant therapy in patients with unstable angina or suspected non‐Q‐wave myocardial infarction: Organization to assess strategies for ischemic syndromes (OASIS) pilot study results. Circulation 1998; 98: 1064–1070 [DOI] [PubMed] [Google Scholar]
- 10. Williams MJ, Morison IM, Parker JH, Stewart RA: Progression of the culprit lesion in unstable coronary artery disease with warfarin and aspirin versus aspirin alone: A preliminary study. J Am Coll Cardiol 1997; 30: 364–369 [DOI] [PubMed] [Google Scholar]
- 11. Antman EM and the Thrombolysis in Myocardial Infarction (TIMI) 11B Trial Investigators : TIMI 11B. Enoxaparin versus unfractionated heparin for unstable angina or non‐Q‐wave myocardial infarction: A double‐blind, placebo‐controlled, parallel‐group, multicenter trial. Rationale, study design, and methods. Am Heart J 1998; 135 (suppl 6): S353–S360 [DOI] [PubMed] [Google Scholar]
- 11. SCRIP (2–4 September, 1998) 2366/2367: 23
- 13. Kong DF, Califf RM, Miller DP, Moliterno DJ, White HD, Harrington RA, Tcheng JE, Lincoff AM, Hasselblad V, Topol EJ: Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation 1998; 98 (25): 2829–2835 [DOI] [PubMed] [Google Scholar]
- 14. Cannon CP, Thompson B, McCabe CH, Mueller HS, Kirshenbaum JM, Herson S, Nasmith JB, Chaitman BR, Braunwald E for the TIMI III Investigators : Predictors of non‐Q‐wave myocardial infarction in patients with acute ischemic syndromes: An analysis from the Thrombolysis in Myocardial Ischemia (TIMI) III trials. Am J Cardiol 1995; 75: 977–981 [DOI] [PubMed] [Google Scholar]
- 15. Murphy JJ, Connell PA, Hampton JR: Predictors of risk in patients with unstable angina admitted to a district general hospital. Br Heart J 1992; 67: 395–401 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD, Concannon CA, Cowan M, Edwards C, Fuster V, Goldman L, Green LA, Grines CL, Lytle BW, McCauley KM, Mushlin AL, Rose GC, Smith EE, Swain JA, Topol EJ, Willerson JT: Diagnosing and managing unstable angina. Circulation 1994; 90: 613–622 [DOI] [PubMed] [Google Scholar]
- 17. Bugiardini R, Borghi A, Pozzati A, Ruggeri A, Puddu P, Maseri A: Relation of severity of symptoms to transient myocardial ischemia and prognosis in unstable angina. J Am Coll Cardiol 1995; 25: 597–604 [DOI] [PubMed] [Google Scholar]
- 18. Lindahl B, Venge P, Wallentin L for the FRISC Study Group : Troponin T identifies patients with unstable coronary artery disease who benefit from long‐term antithrombotic protection. J Am Coll Cardiol 1997; 29: 43–48 [DOI] [PubMed] [Google Scholar]