Unstable angina / non ST elevation myocardial infarction natural history, complications and prognosis

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Unstable Angina
Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women
Heart Failure and Cardiogenic Shock
Perioperative NSTE-ACS Related to Noncardiac Surgery
Stress (Takotsubo) Cardiomyopathy
Diabetes Mellitus
Post CABG Patients
Older Adults
Chronic Kidney Disease
Angiographically Normal Coronary Arteries
Variant (Prinzmetal's) Angina
Substance Abuse
Cardiovascular "Syndrome X"

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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy

Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS

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Complications of Bleeding and Transfusion

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Unstable angina/NSTEMI are signs of severe heart disease. Natural history is complicated by the development of arrhythmias and heart failure. In a study it was shown that 14% of the cases of unstable angina can progress to an MI. Sudden death is an infrequent sequel of both unstable angina and NSTEMI.

Natural History, Complications, and Prognosis

Natural History

Complications

Unstable Angina

List of Factors Affecting the Development and Complications of NSTEMI (In Alphabetical Order)

Prognosis

Unstable Angina

Prognosis in NSTEMI

  • In case of NSTEMI treated non-invasively, elevated levels of high sensitivity troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) are independently associated with an increased risk of myocardial infarction, stroke, and cardiovascular death.
  • In contrast, among patients with NSTEMI treated invasively, elevated levels of only NT-proBNP and GDF-15 have been associated with an increased risk of subsequent myocardial infarction, stroke, and cardiovascular death.[2]

Prediction Rules

References

  1. Morrow DA, de Lemos JA, Sabatine MS, Murphy SA, Demopoulos LA, DiBattiste PM; et al. (2003). "Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18". J Am Coll Cardiol. 41 (8): 1264–72. PMID 12706919.
  2. Wallentin L, Lindholm D, Siegbahn A, Wernroth L, Becker RC, Cannon CP; et al. (2014). "Biomarkers in Relation to the Effects of Ticagrelor in Comparison With Clopidogrel in Non-ST-Elevation Acute Coronary Syndrome Patients Managed With or Without In-Hospital Revascularization: A Substudy From the Prospective Randomized Platelet Inhibition and Patient Outcomes (PLATO) Trial". Circulation. 129 (3): 293–303. doi:10.1161/CIRCULATIONAHA.113.004420. PMID 24170388.

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