Author/Editor		Pust, Borut
Title		Novosti k priporočilom za obravnavo nestabilne angine pektoris
Translated title		Novelties in guidelines for management of unstable angina pectoris
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. 3
Publication year		2002
Volume		str. 181-4
Language		slo
Abstract		Background. Unstable angina pectoris is together with non-transmural or non-Q myocardial infarction, being recently known as non-ST-elevation myocardial infarction, one of the most unpredictible forms of acute coronary syndrome. In majority of cases the patoanatomical substratum is considered acute rupture of an atherosclerotic plaque inducing the cascade of pathological processes including acute arterial thrombosis and spasm with consequent critical reduction of local coronary flow. First clinically useful and generally accepted classification of unstable angina pectoris was proposed by Braunwald in 1989. It was completed by him and a group of experts of the Ministry of Health in 1994, when criteria for the classification according to the degree of risk were added. They were of high practical value in decision making for early invasive or for conservative treatment. He considered early invasive approach medically and economically justified only in high risk group, it is in about 25% of patients admitted as unstable angina pectoris. Some prospective randomized trials being conducted later without of use of troponine test as a measure of risk, without of coronary stents and of glycoproteine IIb/IIIa receptor inhibitors, were not able to demonstrate any reliable advantage of early invasive (first 6 to 48 hours) in respect to conservative approach. Most recent studies well using these three novel methods demonstrated significantly better effects of early invasive approach in high risk group and even in those moderate risk patients having positive troponin test or obvious ischemia on exercise. They represent about 50% of all admitted as unstable angina pectoris. (Abstract trunacted at 2000 characters).
Summary		Izhodišča. Nestabilna angina pektoris sodi skupaj z netransmuralnim oz. z ne-Q miokardin infarktom, katerega v zadnjem času označujemo kot infarkt brez dviga ST spojnice, med najbolj nepredvidljive oblike akutnega koronarnega sindroma. Patoanatomski substrat le-tega je v večini primerov akutni razpok večjega ali manjšega aterosklerotičnega plaka, ki sproži niz patoloških dogajanj, vključno s trombozo in žilnim spazmom, kar kritično zmanjša koronarni pretok. Prvo klinično res uporabno in splošno sprejeto razvrščanje nestabilne angine pektoris je predlagal Braunwald že l. 1989. Dopolnil ga je s skupino izvedencev Ministrstva za zdravstvo ZDA l.1994, ko je dodal merila za razvrščanje tudi po stopnji ogroženosti, kar je imelo praktičen pomen pri odločanju za zgodnje invazivno oz. konzervativno zdravljenje. Pri tem je menil, da je takojšen invazivni pristop medicinsko in ekonomsko upravičen le pri skupini z največjo ogroženostjo, tj. pri približno 25% napotenih z diagnozo nestabilna angina pektoris. Nekatere kasnejše prospektivne randomizirane študije, v okviru katerih troponinski test kot merilo tveganja, koronarne opornice in zaviralci glikoproteinskih receptorjev IIb/IIIa, še niso bili uporabljeni, niso mogle pokazati zanesljive prednosti zgodnjega invazivnega pristopa (v prvih 6 do 48 urah) pred konzervativnim pristopom. Šele prav zadnje študije, ki so v celoti izkoristile le tri novosti, so pokazale statistično pomembno prednost zgodnjega invazivnega pristopa pri vseh bolnikih z visokim tveganjem in celo pri tistih z zmernim tveganjem, če so troponin pozitivni ali če obremenitveni test pokaže očitno ishemijo. Teh pa je približno 50% vseh napotenih z nestabilno angino pektoris. (Izvleček prekinjen pri 2000 znakih).
Descriptors		ANGINA, UNSTABLE MYOCARDIAL INFARCTION TROPONIN PLATELET GLYCOPROTEIN GPIIB-IIIA COMPLEX