The broad spectrum of unstable angina pectoris and its implications for future controlled trials
1986; Elsevier BV; Volume: 58; Issue: 6 Linguagem: Inglês
10.1016/0002-9149(86)90031-7
ISSN1879-1913
AutoresJane-Iris Farhi, Marc Cohen, Valentı́n Fuster,
Tópico(s)Cardiovascular Function and Risk Factors
ResumoI n recent years there have been many studies on the natural history and treatment of patients with “unstable angina,” a clinical syndrome between stable angina pectoris and acute myocardial infarction. Treatment of unstable angina has been directed at reducing cardiac work (p blockers and intravenous nitroglycerin], inhibiting coronary spasm (calcium channel blockers], increasing blood flow (bypass surgery or angioplasty), thrombolysis (streptokinase), and more recently inhibiting platelet aggregation and thrombosis (aspirin, heparin). Each of these modalities has been or is being looked at in major studies to determine immediate impact on patient survival and long-term benefit. However, in reviewing published reports there appears to be major drawbacks that make clinical application of these studies difficult. First, the studies are not uniform with respect to the definition of unstable angina as indicated by their inclusion criteria, resulting in analyses of heterogeneous patient populations. Second, there is a sizable crossover rate from medical to surgical therapy in many trials. This variability affects the interpretation of these trials and makes comparison of similar trials difficult. Third, recent advances regarding the pathophysiology and mechanisms responsible for unstable angina suggest a major role for antithrombotic therapy, a modality that has not yet been adequately tested in a large scale trial. We believe that the results of the natural history studies of patients with unstable angina would be more meaningful based on stratification into low- and high-risk subsets. The insight gained from “subset” analysis of previous trials combined with current
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