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Coronary angiography and revascularization for unstable angina or non-ST elevation acute myocardial infarction

Authors
Jeffrey A Breall, MD, PhD
Michael Simons, MD
Section Editors
Donald Cutlip, MD
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Most patients with a non-ST elevation acute coronary syndrome (unstable angina and non-ST elevation myocardial infarction) undergo coronary angiography and revascularization during the index hospitalization. This topic will summarize the evidence supporting this invasive strategy and discuss our approach to revascularization.

The diagnostic evaluation of a non-ST elevation acute coronary syndrome and the general management of these patients are presented elsewhere. (See "Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department" and "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction".)

DEFINITION OF UA AND NSTEMI

Unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) are part of the continuum of acute coronary syndrome (ACS), which also includes ST-elevation myocardial infarction (STEMI). A detailed discussion of the diagnosis of UA and NSTEMI is presented elsewhere. (See "Criteria for the diagnosis of acute myocardial infarction", section on 'Third universal definition of MI'.)

An acute, evolving, or recent MI is present when there is a typical rise and fall of biochemical markers of myocardial necrosis (troponin is preferred) with at least one of the following [1]:

Ischemic symptoms

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 27 00:00:00 GMT+00:00 2016.
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