Diagnosing and managing unstable angina. Agency for Health Care Policy and Research.

TLDR

The guide offers evidence‑based recommendations for managing unstable angina, derived from extensive literature reviews and expert consensus. Management involves risk‑stratified care: low‑risk patients may be observed outpatient for up to 72 h, while intermediate‑to‑high‑risk patients are hospitalized; thrombolytics are withheld unless myocardial infarction is confirmed; noninvasive testing guides therapy, with coronary angiography and CABG reserved for high‑risk or left‑main disease, and discharge plans emphasize monitoring, aspirin, risk‑factor modification, and counseling. Many patients suspected of unstable angina can be safely discharged home after adequate initial evaluation.

Abstract

This Quick Reference Guide for Clinicians contains recommendations on the care of patients with unstable angina based on a combination of evidence obtained through extensive literature reviews and consensus among members of a private-sector, expert panel. Principal conclusions include: Many patients suspected of having unstable angina can be discharged home after adequate initial evaluation. Further outpatient evaluation may be scheduled for up to 72 hours after initial presentation for patients with clinical symptoms of unstable angina judged at initial evaluation to be at low risk for complications. Patients with acute ischemic heart disease judged to be at intermediate or high risk of complications should be hospitalized for careful monitoring of their clinical course. Intravenous thrombolytic therapy should not be administered to patients without evidence of acute myocardial infarction. Assessment of prognosis by noninvasive testing often aids selection of appropriate therapy. Coronary angiography is appropriate for patients judged to be at high risk for cardiac complications or death based on their clinical course or results of noninvasive testing. Coronary artery bypass surgery should be recommended for almost all patients with left main disease and many patients with three-vessel disease, especially those with left ventricular dysfunction. The discharge care plan should include continued monitoring of symptoms; appropriate drug therapy, including aspirin; risk-factor modification; and counseling.