A patient comes to the hospital with 1 to 2 hours of crushing substernal chest pain and ST-segment depression in V2-V4. He has a history of peptic ulcer disease and diabetes. He currently has melena. Which of the following will result in the greatest decrease in mortality?
A. Metoprolol
B. Angioplasty
C. Captopril
D. Nitrates
E. Emergency bypass
F. Tirofiban
G. Heparin
H. Aspirin
The correct answer is:
A. Angioplasty
The patient is presenting with unstable angina and a major contraindication to the use of anticoaguluants. Angioplasty is the better way to open the artery and prevent further clot formation. Aspirin, heparin, thrombolytics, and the glycoprotein IIb/IIIa inhibitors, such as tirofiban or eptifibatide, cannot be used in patients with serious gastrointestinal bleeding. Beta-blockers will improve mortality but not as much as opening up the blood vessel with angioplasty. Emergency bypass is only performed in the rare case in which anticoagulants and angioplasty either don't work or are contraindicated and the patient is having worsening chest pain and signs of progression to congestive failure