Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. Technique Quantification of LV Function Quantification of Mitral RegurgitationĮditor-In-Chief: C. Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6 TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3ĪCC/AHA Lesion-Specific Classification of the Primary Target Stenosis TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration Standard Views Left Coronary Artery Right Coronary Artery Separate Ostia Anomalous Origins Case Example Fistula The heparin is to be used in addition to aspirin or clopidogrel.Appropriate Use Criteria for RevascularizationĬoronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus These agents should be administered in addition to aspirin and heparin.Īnticoagulation with unfractionated heparin or low-molecular-weight heparin for patients with UA/NSTEMI has an ACC/AHA class I indication. Platelet glycoprotein IIb/IIIa inhibitors have an ACC/AHA class I indication in patients for whom catheterization and percutaneous coronary intervention are planned. When elective coronary artery bypass grafting is planned, clopidogrel should be withheld for five to seven days. The updated ACC/AHA guideline considers the use of clopidogrel in addition to aspirin to have a class I indication in patients with UA/NSTEMI who are undergoing an early noninterventional or interventional approach and are not at high risk for bleeding. The updated ACC/AHA guideline recommends use of the thienopyridine clopidogrel (Plavix) in patients who cannot tolerate aspirin (ACC/AHA class I). Medical treatment includes anti-ischemic therapy (oxygen, nitroglycerin, beta blocker), antiplatelet therapy (aspirin, clopidogrel, platelet glycoprotein IIb/IIIa inhibitor), and antithrombotic therapy (heparin, low-molecular-weight heparin). Hospital care consists of appropriate initial triage and monitoring. During the initial evaluation, the history, physical examination, electrocardiogram, and cardiac biomarkers are used to determine the likelihood that the patient has UA/NSTEMI and to aid in risk assessment when the diagnosis is established. Part I of this two-part article discusses the first two components of management. Management of suspected UA/NSTEMI has four components: initial evaluation and management hospital care coronary revascularization and hospital discharge and post-hospital care. This guideline, which was published in 2000 and updated in 2002, highlights recent medical advances and is a practical tool to help physicians provide medical care for patients with UA/NSTEMI. To help standardize the assessment and treatment of these patients, the American College of Cardiology and the American Heart Association convened a task force to formulate a management guideline. hospitals because of unstable angina and non–ST-segment elevation myocardial infarction (UA/NSTEMI). Each year, more than 1 million patients are admitted to U.S.
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