[Guidelines for the diagnosis and treatment of unstable angina and non-Q myocardial infarction: proposed changes].

Abstract

In 1994, the United States Agency for Health Care Policy and Research issued clinical practice guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction. In the past 5 years, rapid progress has been made in the management of patients with unstable coronary syndromes, and treatment guidelines should be revised to reflect these advances. An international forum of cardiology investigators convened to discuss areas in which the diagnosis and treatment of unstable angina/non-Q-wave myocardial infarction should be modified. Although there were areas of controversy, it was agreed that there is sufficient evidence to recommend the following changes: 1) the use of serum cardiac markers should be expanded to include troponin I and T levels as diagnostic and prognostic tools, 2) low-molecular-weight heparins should replace UH as antithrombin agents, 3) new classes of antiplatelet agents are recommended in addition to aspirin, 4) the use of cholesterol-lowering drugs is appropriate in the long-term management of these patients. The rationale for these suggested revisions, including evidence from pertinent clinical trials, is discussed in detail in the accompanying document.