Unstable angina: Current concepts of pathogenesis and treatment

Archives of Internal Medicine

Volumn 160, Issue 1, 2000, Pages 25-37

  Ambrose, John A ^a   Dangas, George ^b  

^a ST VINCENT S HOSPITAL   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ABCIXIMAB; ACETYLSALICYLIC ACID; ANTIANGINA PECTORIS AGENT; ANTICOAGULANT AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; DALTEPARIN; ENOXAPARIN; EPTIFIBATIDE; FIBRINOGEN RECEPTOR ANTAGONIST; GLYCERYL TRINITRATE; HEPARIN; HIRUDIN; HIRULOG; LAMIFIBAN; LOW MOLECULAR WEIGHT HEPARIN; NITRATE; THROMBIN INHIBITOR; TIROFIBAN;

ANGINA PECTORIS; ANGIOCARDIOGRAPHY; CARDIOVASCULAR DISEASE; CORONARY ARTERY BYPASS GRAFT; CORONARY ARTERY DISEASE; HEART MUSCLE REVASCULARIZATION; HUMAN; PATHOGENESIS; PRIORITY JOURNAL; PROGNOSIS; REVIEW; THROMBOSIS PREVENTION; TRANSLUMINAL CORONARY ANGIOPLASTY; UNSTABLE ANGINA PECTORIS;

EID: 0034627898     PISSN: 00039926     EISSN: None     Source Type: Journal    
DOI: 10.1001/archinte.160.1.25     Document Type: Review

References (112)

1. National Center for Health Statistics. Vital and Health Statistics: Detailed Diagnosis and Procedures Discharged From Short Stay Hospitals. Hyattsville, Md: Public Health Service, US Dept of Health and Human Services; 1987. PHS series 13, No. 90.
2. Braunwaid E, Jones RH, Mark DB, et al. Diagnosing and managing unstable angina. Circulation. 1994;90:613-622.
3. Vakil RJ. Intermediate coronary syndrome. Circulation. 1961;24:557-571.
4. Fowler NO. Preinfarction angina: a need for an objective definition and for a controlled clinical trial of its management. Circulation. 1971;44: 755-758.
5. Braunwald E. Unstable angina: a classification. Circulation. 1989;80:410-414.
6. Calvin JE, Klein LW, VandenBerg BJ, et al. Risk stratification in unstable angina: prospective validation of the Braunwald classification. JAMA. 1995;273:136-141.
7. van Miltenburg-van Zijl AJ, Simoons ML, Veerhoek RJ, Bossuyt PM. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris. J Am Coll Cardiol. 1995;25:1286-1292.
8. Harper RW, Kennedy G, DeSanctis RW, Hunter AM. The incidence and pattern of angina prior to acute myocardial infarction: a study of 577 cases. Am Heart J. 1979;2:178-183.
9. Stowers M, Short D. Warning symptoms before myocardial infarction. Br Heart J. 1970;32: 833-838.
10. Ambrose JA, Winters SI, Stern A, et al. Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol. 1985; 5:605-616.
11. Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total occlusion. Circulation. 1985;71:699-708.
12. Davies MJ, Thomas AC. Plaque fissuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina. Br Heart J. 1985;53:363-373.
13. Ambrose JA. Plaque disruption and the acute coronary syndromes of unstable angina and myocardial infarction: if the substrate is similar, why is the clinical presentation different? J Am Coll Cardiol. 1992;19:1653-1658.
14. Ambrose JA, Monsen C, Borrico S, Gorlin R, Fuster V. Angiographic demonstration of a common link between unstable angina pectoris and non-Q wave acute myocardial infarction. Am J Cardiol. 1988;61:244-247.
15. DeWood MA, Stifter WF, Simpson CS, et al. Coronary arteriographic findings soon after non-Q wave myocardial infarction. N Engl J Med. 1986; 315:417-423.
16. Falk E. Why do plaques rupture? Circulation. 1992;86(suppl 6):III30-III42.
17. Escaned J, van Suylen RJ, MacLeod DC, et al. Histologic characteristics of tissue excised during directional coronary atherectomy in stable and unstable angina pectoris. Am J Cardiol. 1993; 71:1442-1447.
18. Haft JI, Christou CP, Goldstein JE, Carnes RE. Correlation of atherectomy specimen histology with coronary arteriographic lesion morphologic appearance in patients with stable and unstable angina. Am Heart J. 1995;130:420-424.
19. Williams AE, Freeman MR, Chisholm RJ, et al. Angiographic morphology in unstable angina pectoris. Am J Cardiol. 1988;62:1024-1027.
20. Rehr R, Disciascio G, Vevtrovec G, Cowley M. Angiographic morphology of coronary artery stenosis in prolonged rest angina: evidence of intracoronary thrombosis. J Am Coll Cardiol. 1989; 14:1429-1437.
21. Moise A, Theroux P, Taeymans Y, et al. Unstable angina and progression of coronary atherosclerosis. N Engl J Med. 1983;309:685-689.
22. Ambrose JA, Winters SL, Arora RR, Riccio A, Gorlin R, Fuster V. Angiographic evolution of coronary morphology in unstable angina. J Am Coll Cardiol. 1986;7:472-478.
23. Dangas G, Mehran R, Wallenstein S, et al. Correlation between angiographic morphology and clinical presentation in unstable angina. J Am Coll Cardiol. 1997;29:519-525.
24. Smalling RW, Anderson V. Pathophysiology insight into the possible optimal therapies for acute myocardial infarction and unstable angina. Circulation. 1998;97:10-11.
25. Mizuno K, Satomura K, Miyamoto A, et al. Angioscopic evaluation of coronary artery thrombus in acute coronary syndromes. N Engl J Med. 1992;326:287-291.
26. Heijer PD, Foley DP, Escaned J, et al. Angioscopic versus angiographic detection of intimal dissection and intracoronary thrombus. J Am Coll Cardiol. 1994;24:649-554.
27. White C, Ramee SR, Collins TJ, et al. Coronary thrombi increase PTCA risk: angioscopy as a clinical tool. Circulation. 1996;93:253-258.
28. Libby P. Molecular bases of the acute coronary syndromes. Circulation. 1995;91:2844-2850.
29. Annex B-H, Denning SM, Channon KM, et al. Differential expression of tissue factor protein in directional atherectomy specimens from patients with stable and unstable coronary syndromes. Circulation. 1995;91:619-622.
30. Moreno PR, Bernardi VH, Lopez-Cuellar J, et al. Macrophages, smooth muscle cells and tissue factor in unstable angina: implications for cell-mediated thrombogenicity in acute coronary syndromes. Circulation. 1996;94:3090-3097.
31. Liuzzo A, Biasucci LM, Gallimore JR, et al. The prognostic value of C-reactive protein and serum amyloid "a" protein in severe unstable angina. N Engl J Med. 1994;331;417-424.
32. Dangas G, Mehran R, Harpel PC, et al. Lipoprotein(a) and inflammation in human coronary atheroma: association with the severity of clinical presentation. J Am Coll Cardiol. 1998;32:2035-2042.
33. Poon M, Zhang X, Dunsky KG, et al. Apolipoprotein(a) induces monocyte chemotactic activity in human vascular endothelial cells. Circulation. 1997;96:2514-2519.
34. Flugelman MY, Virmani R, Correa R, et al. Smooth muscle cell abundance and fibroblast growth factors in coronary lesions of patients with nonfatal unstable angina: a clue to the mechanism of transformation from the stable to the unstable clinical state. Circulation. 1993;88:2493-2500.
35. Libby P, Egan D, Skarlotos S. Roles of infectious agents in atherosclerosis and restenosis: an assessment of the evidence and need for further research. Circulation. 1997;96:4095-4103.
36. Gazes PC, Mobley EM, Faris HM, Duncan RC, Humphries GB. Preinfarction (unstable) angina: a prospective study: ten year follow-up. Circulation. 1973;48:331-337.
37. Mulcahy R, Awadi AHA, de Buitleor M, et al. Natural history and prognosis of unstable angina. Am Heart J. 1985;109:753-758.
38. Lewis HD Jr, Davis JW, Archibald DG, 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;309:396-403.
39. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone or both in unstable angina: results of a Canadian multicenter trial. N Engl J Med. 1985;313:1375-1396.
40. Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin or both to treat acute unstable angina. N Engl J Med. 1988;319:1105-1011.
41. Wallentin L, for the RISC Group. Risk of myocardial infarction and death during treatment with low-dose aspirin and intravenous heparin in men with unstable angina. N Engl J Med. 1990;827: 830-835.
42. Cohen M, Adams C, Parry G, et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users: primary end points from the ATACS trial. Circulation. 1994;89:81-88.
43. Theroux P, Waters D, Qui S, et al. Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation. 1993;88:2045-2048.
44. Cohen M, Demers C, Gurfinkel EP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease: Efficacy and Safety of Subacute Enoxaparin in Non-Q Wave Coronary Events Study Group. N Engl J Med. 1997;337:447-452.
45. GUSTO IIb Investigators. A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med. 1996;335:775-782.
46. PRISM Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. N Engl J Med. 1998;338:1498-1505.
47. PRISM PLUS Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q wave myocardial infarction. N Engl J Med. 1998;338:1488-1497.
48. PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med. 1998;339:436-443.
49. Schuster EH, Buckley BH. Early post infarction angina: ischemia at a distance and ischemia at the infarct zone. N Engl J Med. 1981;305:1101-1105.
50. Cannon CP, McCabe CH, Stone PH, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J Am Coll Cardiol. 1997; 30:133-140.
51. Adams JE III, Bodor GS, Davila-Roman VG, et al. Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation. 1993;88: 101-106.
52. Ohman EM, Armstrong PW, Christenson RH, et al. Risk stratification with admission cardiac troponin T levels in acute myocardial ischemia. N Engl J Med. 1996;335:1333-1341.
53. DeServi S, Berzuini C, Poma E, et al. Long-term survival and risk stratification in patients with angina at rest undergoing medical treatment. Int J Cardiol. 1989;22:43-50.
54. Bugiardini R, Pozzati A, Borghi A, et al. Angiographic morphology in unstable angina and its relation to transient myocardial ischemia and hospital outcome. Am J Cardiol. 1991;67:460-464.
55. Gottlieb SO, Weisfeldt ML, Ouyang P, et al. Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina. N Engl J Med. 1986;314:1214-1219.
56. Romeo F, Rosano GMC, Maruscelli E, et al. Unstable angina: role of silent ischemia and total ischemic time (silent plus painful ischemia): a 6-year follow-up. J Am Coll Cardiol. 1992;19: 1173-1179.
57. Diagnosing and Managing Unstable Angina: Quick Reference Guide for Clinicians. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 1994. No. 10.
58. Farkouh ME, Gabriel SE, Evans RW, et al. A population-based evaluation of the AHCPR guideline for management of unstable angina: the Olmstead County Chest Pain Study. Circulation. 1996; (suppl I):10.
59. Theroux P, Taymans Y, Morisette D, et al. A randomized study comparing propranolol and diltiazem in the treatment of unstable angina. J Am Coll Cardiol. 1985;5:717-722.
60. The Holland Inter-University Nifedipine/ Metoprolol Trial (HINT) Research Group. Early treatment of unstable angina in the coronary care unit: a randomized, double-blind, placebo-controlled comparison of recurrent ischemia in patients treated with nifedipine or metopropol or both. Br Heart J. 1986;56:400-413.
61. Mikolich JR, Nicoloff NB, Robinson PH, Logue RB. Relief of refractory angina with continuous intravenous infusion of nitroglycerin. Chest. 1980; 77:375-379.
62. 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;260:2259-2263.
63. Robertson RM, Wood AJ, Vaughn WK, et al. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;6:281-286.
64. Telford A, Wilson C. Trial of heparin versus atenolol in prevention of myocardial infarction in intermediate coronary syndrome. Lancet. 1981; 1:1225-1228.
65. Theroux P, Water D, Lam J, et al. Reactivation of unstable angina after the discontinuation of heparin. N Engl J Med. 1992;327:141-145.
66. Nurmohamed NT, Rosendaal FR, Buller HR, et al. Low-molecular-weight heparin versus standard heparin in general and orthopedic surgery: a meta-analysis. Lancet. 1992;340:152-156.
67. The FRISC Study Group. Low-molecular-weight heparin during instability in coronary artery disease. Lancet. 1996;347:561-568.
68. Klein W, Buchwald A, Hillis SE, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery events study group. N Engl J Med. 1997; 96:61-68.
69. Cohen M, Bigonzi F, Le louer V, et al. One year follow-up of the ESSENCE trial (enoxaparin versus heparin in unstable angina and non-Q wave infarction) [abstract]. J Am Coll Cardiol. 1998; 31:79.
70. Antman EM, McCabe CH, Gurfinkel EP, 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) IIB Trial. Circulation. 1999;100:1593-1601.
71. Loscalzo J. Thrombin inhibitors in fibrinolysis: a Hobson's choice of alternatives. Circulation. 1996;94:863-865.
72. Coller BS. Monitoring platelet GP IIb/IIIa antagonists therapy. Circulation. 1998;97:5-9.
73. PARAGON Investigators. International, randomized, controlled trial of lamifiban (a platelet glycoprotein IIb/IIIa inhibitor), heparin or both for unstable angina. Circulation. 1998;97:2386-2395.
74. Israel DH, Ambrose JA. Angiographic correlations of complex lesions in acute coronary syndromes. In: Ambrose J, ed. Complex Lesions in Acute Coronary Syndromes, New York, NY: Future Publishing; 1996:49-72.
75. TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave infarction: results of the TIMI IIIB trial. Circulation. 1994;89:1545-1556.
76. Boden WE, O'Rourke RA, Crawford MH, et al. Outcome in patients with acute non-Q wave myocardial infarction randomly assigned to an invasive as compared with conservative management strategy. N Engl J Med. 1998;338:1785-1792.
77. Yusuf S, Flather M, Poguee J, et al. Variations between countries in invasive procedures and outcome in patients with suspected unstable angina or myocardial infarction without initial ST elevation. Lancet. 1998;352:507-514.
78. Butman SM, Olson HG, Butman LK. Early exercise testing after stabilization of unstable angina: correlation with coronary angiographic findings and subsequent cardiac events. Am Heart J. 1986;111:11-18.
79. Swahn E, Areskog M, Wallentin L. Prognostic importance of early exercise testing in men with suspected unstable coronary artery disease. Eur Heart J. 1987;8:861-869.
80. Williams DO, Riley RS, Singh AK, et al. Evaluation of the role of coronary angioplasty in patients with unstable angina pectoris. Am Heart J. 1981;102:1-9.
81. Meyer J, Schmitz HJ, Kiesslich T, et al. Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results. Am Heart J. 1983;106:973-980.
82. de Feyter PJ, Serruys PW. PTCA for unstable angina. In: Topol EJ, ed. Textbook of Interventional Cardiology. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1994;274-291.
83. Gulba DC, Daniel WG, Simon R, et al. Role of thrombolysis and thrombus in patients with acute coronary occlusion during percutaneous transluminal angioplasty. J Am Coll Cardiol. 1990;16: 563-568.
84. Schieman G, Cohen BM, Kozima J. et al. Intracoronary urokinase for intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty in acute ischemic syndromes. Circulation. 1990;82:2052-2060.
85. Gourdreau E, Disciascio G, Vetrovec GW, et al. Intracoronary urokinase as an adjunctive to percutaneous transluminal coronary angioplasty in patients with complex coronary narrowing or angioplasty induced complications. Am J Cardiol. 1993;69:57-62.
86. Ambrose JA, Almeida OD, Sharma S, et al. Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina: results of TAUSA Trial. Circulation. 1994;90:69-77.
87. Bittl JA, Strony J, Brinker JA, et al. Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. N Engl J Med. 1995;333: 764-769.
88. Serruys PW, Herman JR, Simon R, et al. A comparison of hirudin with heparin in the prevention of restenosis after coronary angioplasty. N Engl J Med. 1995;333:757-763.
89. EPIC Investigators. Use of monoclonal antibody directed against platelet glycoprotein IIb/ IIIa receptor in high-risk coronary angioplasty. N Engl J Med. 1994;330:956-961.
90. Jordan RE, Wagner CL, Mascelli MA, et al. Pre-clinical development of c7E3fab: a mouse/ human chimeric monoclonal antibody fragment that inhibits platelet function by blockage of GPIIb/IIIa receptor with observations on the immunogenetics of c7E3fab in humans. In: Horton MA, ed. Adhesion Receptors as Therapeutic Agents. Boca Raton, Fla: CRC Press Inc; 1996: 281-302.
91. Coller BS. GP IIb/IIIa antagonists: pathophysiologic and therapeutic insights from studies of c7E3fab. Thromb Haemost. 1997;26:285-293.
92. Lincoff AM, Califf RM, Anderson KM, et al. Evidence for prevention of death and myocardial infarction with platelet membrane glycoprotein IIb/ IIIa receptor blockade by abciximab (c7E3fab) among patients with unstable angina undergoing percutaneous coronary revascularization. J Am Coll Cardiol. 1997;30:149-156.
93. The EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med. 1997;336:1689-1696.
94. The CAPTURE Investigators. Randomized, placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study. Lancet. 1997;349: 1429-1435.
95. The RESTORE Investigators. Effects of platelet glycoprotein IIb/IIIa blockage with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation. 1997; 96:1445-1453.
96. The IMPACT II Investigators. Randomized, placebo-controlled trial of effect of eptifibatide on complication of percutaneous coronary intervention: IMPACT II. Lancet. 1997;349:1422-1428.
97. Phillips DR, Teng W, Arfsten A, et al. Effect of Ca++ on GP IIb/IIIa interactions with intergrillin: enhanced GP IIb/IIIa binding and inhibition of platelet aggregation by reductions in the concentration of ionized calcium in plasma anticoagulated with citrate. Circulation. 1997;96:1488-1494.
98. Tcheng JE, Kereiakes DJ, George BS, et al. Safety of readministration of abciximab: interim results of the ReoPro Readministration Registry [abstract]. J Am Coll Cardiol. 1998;31:55A.
99. Marzocchi A, Piovaccari G, Marronzzini C, et al. Results of coronary stenting for unstable versus angina pectoris. Am J Cardiol. 1997;79: 1314-1318.
100. Stone GW, Brodie BR, Griffin JH, et al. Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day results of the PAMI Stent Pilot Trial. J Am Coll Cardiol. 1998; 31:23-30.
101. Takaro A, Holtgren HN, Lipton MJ, Detre KM. The VA cooperative randomized study of surgery for coronary arterial occlusive disease, II: subgroup with significant left main lesions: cardiovascular surgery 1975. Circulation. 1976;54 (suppl 3):107-117.
102. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med. 1985;311: 1333-1339.
103. European Coronary Surgery Study Group. Prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet. 1998;2:249-275.
104. CASS Principal Investigators and their associates. Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery: survival data. Circulation. 1983;68:939-950.
105. Unstable angina pectoris: national cooperative study group to compare surgical and medical therapy, I: report of protocol and patient population. Am J Cardiol. 1976;37:896-902.
106. Unstable angina pectoris: National Cooperative Study Group to Compare Surgical and Medical Therapy, II: in-hospital experience and initial follow-up results in patients with one, two and three vessel disease. Am J Cardiol. 1978;42: 839-848.
107. Scott SM, Luchi RJ, Deupree RH, Veterans Administration Unstable Angina Cooperative Study Group. Veterans Administration Cooperative Study for treatment of patients with unstable angina: results in patients with abnormal left ventricular function. Circulation. 1988;78(suppl 3): 113-121.
108. Parisi AF, Khuri S, Deupree RH, et al. Medical compared with surgical management of unstable angina: 5-year mortality and morbidity in the Veterans Administration Study. Circulation. 1989;80:1176-1189.
109. Hamm CW, Reimers J, Ischinger T, et al. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. N Engl J Med. 1994;331:1037-1043.
110. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with symptomatic multivessel coronary disease. N Engl J Med. 1994; 331:1037-1043.
111. King SB II, Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery. N Engl J Med. 1994;331:1044-1050.
112. Rahimtoola SH, Nunley D, Grunkemeier G, et al. Ten-year survival after coronary bypass surgery for unstable angina. N Engl J Med. 1983; 308:676-681.