Effect of maximal medical therapy on refractoriness of unstable angina pectoris
dc.contributor.author | Grambow, David W. | en_US |
dc.contributor.author | Topol, Eric J. | en_US |
dc.date.accessioned | 2006-04-10T15:06:37Z | |
dc.date.available | 2006-04-10T15:06:37Z | |
dc.date.issued | 1992-09-01 | en_US |
dc.identifier.citation | Grambow, David W., Topol, Eric J. (1992/09/01)."Effect of maximal medical therapy on refractoriness of unstable angina pectoris." The American Journal of Cardiology 70(6): 577-581. <http://hdl.handle.net/2027.42/29885> | en_US |
dc.identifier.uri | http://www.sciencedirect.com/science/article/B6T10-4FWD9FS-5Y/2/93493ac0de8514993448f5faf4f9dbb7 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/29885 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=1354937&dopt=citation | en_US |
dc.description.abstract | A group of 125 patients with unstable angina were studied over a 5-year period to define the incidence of refractory unstable angina in the current era of 5-drug medical therapy with intravenous heparin, aspirin, nitrates, calcium antagonists and[beta] blockers. All patients had >20 minutes of chest pain at rest with reversible electrocardiographic changes occurring in the absence of myocardial infarction. Patients were considered refractory only if chest pain continued despite treatment with maximal 5-drug therapy. At the time of transfer to the center, 65 patients continued to have ischemic chest pain at rest and were considered "medically refractory" by their referring physicians. A more aggressive medical regimen was used, and 54 patients (83%) were rendered chest pain-free. Of the 11 truly refractory patients (8.8%), coronary arteriography revealed an increased likelihood of left main or 3-vessel disease (7 of 11 vs 26 of 114; P = 0.01). Inhospital treatment strategies for the 114 patients stabilized with medical therapy included continued medical therapy (n = 37), coronary angioplasty (n = 46) and bypass grafting (n = 31). The rate of myocardial infarction or death in patients managed medically was 3%. Coronary angioplasty in medically stabilized patients was complicated by an abrupt closure rate of 26%, and a 17% rate of myocardial infarction, death or need for emergency bypass grafting. Medically stabilized patients undergoing bypass grafting had a 9% rate of myocardial infarction or death. Unstable angina truly refractory to current, maximal medical therapy is infrequent (8.8%). However, the refractory group is vulnerable to adverse angioplasty results and cardiac events. | en_US |
dc.format.extent | 654399 bytes | |
dc.format.extent | 3118 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.language.iso | en_US | |
dc.publisher | Elsevier | en_US |
dc.title | Effect of maximal medical therapy on refractoriness of unstable angina pectoris | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialties | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | University of Michigan Medical Center, Ann Arbor, Michigan, and the Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A. | en_US |
dc.contributor.affiliationum | University of Michigan Medical Center, Ann Arbor, Michigan, and the Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A. | en_US |
dc.identifier.pmid | 1354937 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/29885/1/0000238.pdf | en_US |
dc.identifier.doi | http://dx.doi.org/10.1016/0002-9149(92)90194-4 | en_US |
dc.identifier.source | The American Journal of Cardiology | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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