TABLA 6.

Indicaciones cirugía de bypass en los pacientes con angina inestable según las recomendaciones de la Sociedad Española de Cardiología

Clase I

Angina inestable refractaria a tratamiento médico adecuado.

Angina inestable recurrente tras una inicial estabilización.

Angina inestable controlada con tratamiento médico y riesgo alto o intermedio de eventos adversos graves en la evaluación inicial o en la estratificación posterior.

Clase IIb

Angina inestable controlada con tratamiento médico y criterios de bajo riesgo inicial y sin criterios de alto riesgo en la estratificación posterior.

Clase III

Angina inestable, con datos de "alto riesgo", en pacientes con anatomía coronaria en los que no se considera técnicamente posible la revascularización coronaria.

Angina inestable en pacientes no candidatos a revascularización por expectancia de vida limitada.

7. BIBLIOGRAFÍA

1.     Bhatt DL, Flather MD. Manual de síndromes coronarios agudos. Ed. J&C Ediciones Médicas, Barcelona 2004.

2.     Topol EC (ed). Acute Coronary Syndromes. Marcel Dekker Inc. New York, 2004.

3.     Cannon CP. Management of Acute Coronary Syndromes. Humana Press, Totowa, 2003.

4.     Braunwald, E, Antman, E, Beasley, J, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002; 40:1366.

5.     López-Bescos L, Arós Borau F, Lidón Corbi RM, et al. Actualización (2002) de las Guías de práctica clínica de la Sociedad Española de Cardiología en angina inestable/infarto sin elevación del segmento ST. Rev Esp Cardiol 2002; 54: 631.

6.     Bertrand ME, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recomendations of the Task Force of the European Society of Cardiology. Eur Heart J 2000;21:1406-32.

7.     Hirsh J. Guidelines for antithrombotic therapy. BC Decker Inc, Hamilton, 2005.

8.     Yusuf, S, Mehta, SR, Zhao, F, et al. Early and late effects of clopidogrel in patients with acute coronary syndromes. Circulation 2003; 107:966.

9.     Budaj, A, Yusuf, S, Mehta, SR, et al. Benefit of clopidogrel in patients with acute coronary syndromes without ST-segment elevation in various risk groups. Circulation 2002; 106:1622.

10.   Hongo, RH, Ley, J, Dick, SE, Yee, RR. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 2002; 40:231.

11.   Prasad A, Mathew V, Holmes DR, Gersh BJ. Current management of non-ST-segment-elevation acute coronary syndrome: reconciling the results of randomized controlled trials. Eur Heart J 2003;24:1544.

12.   Mehta, SR, Yusuf, S, Peters, RJG, et al, for the CLopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358:527.

13.   Steinhubl, SR, Berger, PB, Mann JT, 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288:2411.

14.   Boersma, E, Harrington, RA, Moliterno, DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet 2002; 359:189.

15.   Morrow, DA, Antman, EM, Snapinn, SM, et al. An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes. Application of the TIMI risk score for UA/NSTEMI in PRISM-PLUS. Eur Heart J 2002; 23:223.

16.   Cohen M, Demers G, Gurfinkel E, Turpie AG, Fromell GJ, Goodman S, et al.. A comparison of low molecular weight heparin with unfractioned heparin for unstable coronary artery disease. N Engl J Med 1997;337:447-52.

17.   Antman EM, McCabe CH, Gurfinkel EP, Turpie AGG, Bernink PJLM, Salein D, et al.. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the Thrombolysis In Myocardial Infarction (TIMI) 11B Trial. Circulation 1999;100:1593-601.

18.   Fragmin During Instability in Coronary Artery Disease (FRISC) study group.. Low-molecular-weight heparin during instability in coronary artery disease. Lancet 1996;347:561-8

19.   The FRAXIS Study Group. Comparison of two treatment durations (6 days and 14 days) of a low molecular weight heparin with a 6-day treatment of unfractionated heparin in the initial management of unstable angina or non-Q wave myocardial infarction: FRAXIS (FRAXiparine in Ischemic Syndrome). Eur Heart J 1999;20:1553-62.

20.   Bybee KE, Wrights RS, Williams BA, Murphy JG, Holmes DR, Kopecky SL. Effect of concomitant or very early statin administration on in-hospital mortality and reinfarction in patients with acute myocardial infarction. Am J Cardiol 2001;87:771-774.

21.   Wright RS, Murphy JG, Bybee KA, et al. Statin lipid-lowering therapy for acute myocardial infarction and ustable angina: efficacy and mechanism of benefit. Mayo Clin Proc 2002;77:1085-92.

22.   Stenestrand U, Wallentin L. Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-36

23.   Aronow HD, Topol EJ, Roe MT, et al. Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study. Lancet 2001; 357:1063-68.

24.   Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of Atorvastatin on early recurrent ischemic events in acute coronary syndromes. The MIRACL study: A randomised controlled trial. JAMA 2001;285:1711-18 .

25.   Serebruany VL, Malinin AI Kallahan KP, et al. Statins do not affect platelet inhibition with clopidogrel during coronary stenting. Atherosclerosis 2001;239:259-61.

26.   Heeschen C, Hamm CW, Laufs U, et al, on behalf of the Platelet Receptor Inhibition in Ischemic Syndrome management (PRISM) Investigators. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation 2002;105:1446-52.

27.   Muhlestein JB, Horne BD, Bair TL, et al. Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol 2001;87:257-61.