From the Guidelines
NSTEMI (Non-ST Elevation Myocardial Infarction) and angina are distinct cardiac conditions, with NSTEMI representing actual heart muscle damage due to partial blockage of a coronary artery, whereas angina is temporary chest pain without permanent heart damage, caused by reduced blood flow to the heart, as defined by the 2012 ACCF/AHA guidelines 1. The main difference between the two conditions lies in the severity of the cardiac damage and the presence of elevated cardiac biomarkers, such as troponin. NSTEMI is diagnosed through a combination of symptoms, ECG changes, and elevated troponin levels, whereas angina typically shows normal biomarkers and may exhibit transient ECG changes of ischemia 1.
Key Differences
- NSTEMI represents an actual heart attack with myocardial damage, whereas angina is a warning sign of coronary artery disease without permanent heart damage.
- NSTEMI is diagnosed through elevated cardiac biomarkers (troponin) in blood tests, along with symptoms and ECG changes, whereas angina typically shows normal biomarkers.
- Treatment for NSTEMI is more aggressive, often requiring hospitalization, antiplatelet therapy, anticoagulation, and early cardiac catheterization, whereas angina is typically managed with anti-anginal medications and lifestyle modifications.
Diagnostic Criteria
According to the 2012 ACCF/AHA guidelines, the diagnosis of NSTEMI is established if a biomarker of myocardial necrosis, such as troponin, has been released, whereas the diagnosis of angina is considered if no biomarker of myocardial necrosis has been released 1.
Management
Both conditions require risk factor management, including blood pressure control, cholesterol management with statins, smoking cessation, and diabetes control. However, the treatment approach differs significantly between NSTEMI and angina, with NSTEMI requiring more aggressive management to prevent further cardiac damage 1.
From the Research
Difference between NSTEMI and Angina
The main difference between Non-ST-Elevation Myocardial Infarction (NSTEMI) and angina is the presence of cardiac biomarker elevation in NSTEMI, indicating myocardial necrosis, whereas angina is characterized by chest pain or discomfort due to transient myocardial ischemia without biomarker elevation 2.
Key Characteristics
- NSTEMI is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute events 2.
- Angina, on the other hand, is characterized by chest pain or discomfort due to transient myocardial ischemia without biomarker elevation.
- Both conditions are acute coronary syndromes, but they have different pathophysiological mechanisms and clinical presentations 3, 4, 5, 6.
Diagnostic Approach
- The diagnosis of NSTEMI and angina involves integration of information from the history, physical exam, electrocardiogram, and cardiac biomarkers 3.
- Early diagnosis and risk stratification of patients with NSTEMI and angina enable the physician to initiate timely, appropriate treatment 3, 5, 6.
- The American College of Cardiology and the American Heart Association have published guidelines for the management of NSTEMI and angina, which emphasize the importance of early risk stratification and aggressive medical therapy 3, 4, 5, 6, 2.
Treatment Strategies
- Treatment strategies for NSTEMI and angina include anti-ischemic, anti-platelet, and anti-thrombotic agents, as well as invasive therapies such as percutaneous coronary intervention and coronary artery bypass grafting 3, 4, 5, 6, 2.
- The choice of treatment strategy depends on the individual patient's risk profile and clinical presentation 3, 4, 5, 6, 2.