Hopp til hovedinnhold

Angina pectoris, ustabil

Sist oppdatert: Sist revidert:
Sist revidert av:


Definisjon:
Ustabil angina pectoris er anginaanfall som opptrer ved stadig mindre anstrengelser, ev. i hvile. Tilstanden oppfattes som et truende hjerteinfarkt og kalles akutt koronarsyndrom før bekreftet diagnose
Forekomst:
I den industrialiserte verden er den årlige insidensen av ustabil angina pectoris ca. 6 per 10.000
Symptomer:
Presenterer seg på ulike måter: som første episode med angina, langvarig angina, vedvarende i hvile, anginasmerter som øker over tid, angina som utløses ved stadig lavere belastning, postinfarkt angina som fortsetter i mer enn 24 timer
Funn:
Kliniske funn er sparsomme ved koronarsykdom uten komplikasjoner
Diagnostikk:
Aktuelle undersøkelser er EKG, infarktmarkører, ekko-kardiografi, belastnings-EKG, koronarangiografi, ev. myokardscintigrafi
Behandling:
For de fleste gjøres PCI, ev. bypass. Legemidler som salisylat, klopidogrel, betablokker, statin
  1. Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2021; 42: 1289-1367. doi:10.1093/eurheartj/ehaa575 DOI  
  2. Simons M. Classification of unstable angina and non-ST elevation myocardial infarction. UpToDate, last updated June 24, 2013. UpToDate  
  3. Shah ASV, Anand A, Strachan FE, et al. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. Lancet 2018; 392: 919-928. pmid:30170853 PubMed  
  4. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation 2013; 127:2452. Circulation  
  5. Jahnke C, Paetsch I, Nehrke K, et al. Rapid and complete coronary arterial tree visualization with magnetic resonance imaging: feasibility and diagnostic performance. Eur Heart J 2005; 26: 2313-9. European Heart Journal  
  6. Williams MC, Hunter A, Shah AS, et al. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. J AM Coll Cardiol 2016; 67: 1759-68. pmid:27081014 PubMed  
  7. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2002;40: 1366-74. PubMed  
  8. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 2000;21: 1406-32. European Heart Journal  
  9. Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ 2003; 326: 1259-61. PubMed  
  10. Lagerqvist B, Husted S, Kontny F, et al. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet 2006; 368: 998-1004. PubMed  
  11. NICE guidelines. Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE guidelines CG181 2014.
  12. Mohr FW, Morice M-C, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629-38. pmid:23439102 PubMed  
  13. Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndrome. A collaborative meta-analysis of randomized trials. JAMA 2005; 293: 2908-17. Journal of the American Medical Association  
  14. O'Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction. A meta-analysis. JAMA 2008; 300: 71-80. Journal of the American Medical Association  
  15. Costa F, Van Kleveren D, Feres F, et al. Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting. JACC 2019. pmid:30784667 PubMed  
  16. The joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined - a consensus document of the joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502-13. European Heart Journal  
  17. Al-Anee K, Al-Ani A, Henriksen M, Halvorsen BA, Sirnes PA. Dødelighet etter akutt koronarsyndrom. Tidsskr Nor Lægeforen 2007; 127: 1628-30. PubMed  
  18. Kappetein AP, Feldman TE, Mack MJ, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011; 32: 2125-34. pmid:21697170 PubMed  
  19. Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018; 391: 939. pmid:29478841 PubMed  
  20. Head SJ, Milojevic M, Daemen J, et al. Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization. J Am Coll Cardiol 2018; 72: 386. pmid:30025574 PubMed  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL
  • Eva Swahn, professor och överläkare, Kardiologiska kliniken, Universitetssjukhuset Linköping (Medibas)

Tidligere fagmedarbeidere

  • Eivind Meland, dr. med., spesialist allmennmedisin, 1. amanuensis, Institutt for allmennmedisin, Universitetet i Bergen