UA/ Non-STEMI

Angina is considered to be unstable if it is prolonged (lasting more than 20 minutes), if it occurs at rest.

Unstable angina:
absence of biochemical evidence of myocardial damage
clinical findings of prolonged (>20 minutes) angina at rest

NSTEMI is distinguished from UA by the presence of elevated serum biomarkers. ST segment elevations and Q waves are absent in

both UA and NSTEMI. As a result, UA and NSTEMI are frequently indistinguishable at initial evaluation since an elevation in serum

biomarkers is usually not detectable for four to six hours after an MI, and at least 12 hours are required to detect elevations in all

patients.


DX:
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Cardiac biomarkers (troponin I or T, and creatine kinase-MB [CK-MB]) should be measured on presentation.

CK-MB has low sensitivity during early (<6 hours) or late (>36 hour) symptom onset and for minor damage.
CK-MB also has low specificity

Both troponin T (TnT) and troponin I (TnI) are more specific but have lower sensitivity for the very early detection of myocardial

necrosis. If the early (<6 hours from symptom onset) troponin test is normal, it should be repeated after 8 to 12 hours.
Troponin remains elevated up to 10 to 14 days after release.

ECG findings in UA/NSTEMI: normal or ST depression +- T wave inversion

A repeat ECG should be performed at 6 and 24 hours and if clinical status changes.


{즉,
Normal ECG -> repeat after 8 hrs.
Normal CK-MB, Trop I -> repeat after 8 hrs.
}

RX:
-----------

{
MONA

BS

invasive approach or non-invasive approach
}

MONA (aspirin 300 mg + clopidogrel 300 mg)
(antiplatelet continuation dose - aspirin 75 mg + clopidogrel 75 mg daily PO)
exclude use of errectile drugs (e.g.viagra) before using nitrate.

B(beta blocker)  S(statin)

Invasive approach:
-PCI/CABG plus abciximab IVI

Non-invasive approach:
-Enoxaparin sodium 1 mg/kg SC 12hrly X 7 days  plus abciximab IVI

An aggressive approach to reperfusion using PCI is best suited for patients with an elevated troponin level or a TIMI risk score ≥5 or

possibly other high-risk features. (See 'High-risk patient' below.) For patients at lower risk, approaches vary based upon hospital

protocol.

Fibrinolytic therapy is not beneficial in patients with a non-ST elevation ACS. (-> This is the difference between STEMI and Non-

STEMI) Therefore, thrombolytic therapy should NOT be administered to patients with UA or NSTEMI unless subsequent ECG

monitoring documents ST segment elevations that persist.