Unstable angina pectoris: a comparison of the costs of medical and surgical treatment

Risk stratification post-myocardial infarction: is early coronary angiography the more effective strategy?

The primary management strategy for the post-myocardial infarction patient continues to be controversial despite published guidelines. In part, this is the consequence of study designs that are not directly applicable to individual patients, but also to the rapidly changing pharmacological and mechanical device armamentarium that rapidly renders clinical trial results obsolete within a few years. This review attempts to highlight those areas where there is consensus as well as to explicate those situations where common clinical practice appears to be in conflict with accepted guidelines.

Critically examining intensive care

The economic recession of the last decade brought intensive care systems under the light of cost-effectiveness analysis, making use of several instruments available in medical practice, and others adapted from for-profit enterprises. The present concept of intensive care, particularly its functional and organizational interactions with traditional specialties, is at the brink of an important revaluation. Studies of the cost-effectiveness of therapeutic actions may be grossly biased if they do not consider the complete process of care (before, during, and after treatment), analyzing even its smallest elements.

Identification of transient and persistent segmental wall motion abnormalities in patients with unstable angina by two-dimensional echocardiography

To determine the value of real-time, two-dimensional echocardiography (2-D echo) in unstable angina, regional wall motion on serial short-axis 2-D echo recordings was analyzed and summed segment scores of abnormal motion were compared and classified according to each patient's clinical status 12 weeks after hospital discharge. Nineteen male patients who fulfilled criteria for unstable angina and responded to medical therapy underwent 2-D echo study within 48 hours of admission and discharge. Of 11 patients with abnormal 2-D echo scores on admission, five patients had reduced scores and six patients had similar or increased scores at discharge. Six of eight patients who had scores of zero on admission had scores of zero at discharge. At follow-up, 11 patients had minimal or no angina pectoris (group 1), and eight patients had worsening angina or recurrent unstable angina (group 2). At discharge, 2-D echo studies showed that all group 1 patients had reduced or zero scores, while group 2 patients retained or increased their abnormal scores. This study shows that in patients with unstable angina, both transient and persistent abnormalities can be identified by 2-D echo. Abnormal segmental wall motion was transient or absent in patients with a good outcome, and worsened or remained abnormal in patients with a poor outcome.