50 yo F with NSTEMI (s\/p PCI stents, about 4 years ago) admitted with unstable angina (UA), TIMI risk score of 3 (intermediate risk) with persistent angina despite aggressive medical therapy meeting criteria for early invasive management with cardiac catheterization.<\/p>\n
Definition:\u00a0Angina at rest or new\/worsening angina with no elevation of cardiac enzymes.<\/p>\n
Goals of discussion:\u00a0 How to choose medical management strategies, risk stratification and criteria for early invasive treatment.<\/p>\n
Teaching points:<\/p>\n
– UA can be\u00a0differentiated\u00a0from NSTEMI by checking cardiac enzymes<\/p>\n
– 20% of NSTEMI patients have no EKG abnormalities<\/p>\n
– STE >0.5 mm in aVR implies a a possibility of left main or 3 vessel\u00a0disease<\/p>\n
– Some of the indications for early invasive therapy (cath +\/- PCI) are hemodynamic\/ arrhythmic\u00a0instability, high TIMI score 5 to 7, refractory angine despite aggressive medical therapy, PCI within past 6 mos\/ prior CABG, new CHF, new\/ worsening MR, EF<40%<\/p>\n
– Risk stratification using TIMI score (most commonly used), Braunwald’s classification and others<\/p>\n