Guidelines in review: Comparison of the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2017 ◽  
Vol 25 (3) ◽  
pp. 769-776 ◽  
Author(s):  
Shane P. Prejean ◽  
Munaib Din ◽  
Eliana Reyes ◽  
Fadi G. Hage
Keyword(s):  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines ◽  
St Elevation

scholarly journals Surgical revascularization for acute coronary syndromes: a report from the North Rhine-Westphalia surgical myocardial infarction registry

2020 ◽  
Vol 58 (6) ◽  
pp. 1137-1144
Author(s):  
Oliver J Liakopoulos ◽  
Ingo Slottosch ◽  
Daniel Wendt ◽  
Hendryk Welp ◽  
Wolfgang Schiller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
Left Ventricular Ejection ◽  
Logistic Euroscore ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation

Abstract OBJECTIVES The aim of this was to analyse current outcomes in patients referred to coronary artery bypass grafting (CABG) for acute coronary syndromes (ACSs), including ST-elevation or non-ST-elevation ACS (non-ST-segment elevation myocardial infarction) or unstable angina. METHODS Patients (n = 2432) undergoing CABG for ACS between January 2010 and December 2017 were prospectively entered into a surgical myocardial infarction registry in North Rhine-Westphalia, Germany. Key end points were in-hospital all-cause mortality (IHM) and major adverse cardio-cerebral events (MACCE). Predictors for IHM and MACCE were analysed by multivariable logistic regression. RESULTS Patients (78% males) were referred for CABG for unstable angina (25%), non-ST-segment elevation myocardial infarction (50%), and ST-segment elevation myocardial infarction (25%). The mean patient age was 68 ± 11 years, logistic EuroSCORE was 19 ± 18% and three-vessel and left main stem diseases were diagnosed in 81% and 45% of patients, respectively. On-pump CABG with cardiac arrest or beating heart was performed in 92% and 2%, respectively, with only 6% off-pump surgery and 6% multiple arterial revascularization (3.1 ± 1.0 grafts, 93% left internal thoracic artery). Emergency CABG was performed in 23% of patients (42% in ST-segment elevation myocardial infarction; P < 0.001). The total IHM and MACCE rates were 8.1% and 17.5% and were highest in ST-segment elevation myocardial infarction patients with 12.6% and 28.5%, respectively (P < 0.001). Key predictors for IHM and MACCE were female gender, elevated troponin, left ventricular ejection fraction, inotropic support, logistic EuroSCORE, cardiopulmonary bypass and aortic clamp time and the need for emergency CABG. CONCLUSIONS Surgical myocardial revascularization in patients with ACS is still linked to substantial in-hospital mortality. Emergency CABG for patients with ACS was associated with poorer outcomes.

scholarly journals Almanac 2013: acute coronary syndromes

2013 ◽  
Vol 19 (2) ◽  
pp. 30-38
Author(s):  
Pascal Meier ◽  
Alexandra J. Lansky ◽  
Andreas Baumbach
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Acute Coronary Syndromes ◽  
Sudden Cardiac Arrest ◽  
Antiplatelet Agents ◽  
Coronary Artery Plaque ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation

Summary Unstable coronary artery plaque is the most common underlying cause of acute coronary syndromes (ACS) and can manifest as unstable angina, non-ST segment elevation infarction (NSTE-ACS), and ST elevation myocardial infarction (STEMI), but can also manifest as sudden cardiac arrest due to ischaemia induced tachyarrhythmias. ACS mortality has decreased significantly over the last few years, especially from the more extreme manifestations of ACS, STEMI, and cardiac arrest. This trend is likely to continue based on recent therapeutic progress which includes novel antiplatelet agents such as prasugrel, ticagrelor and cangrelor.

ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation

2012 ◽  
Vol 65 (2) ◽  
pp. 173 ◽  
Author(s):  
Christian W. Hamm ◽  
Jean-Pierre Bassand ◽  
Stefan Agewall ◽  
Jeroen Bax ◽  
Eric Boersma ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

scholarly journals The IFCC Clinical Application of Cardiac Biomarkers Committee’s Appraisal of the 2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation: Getting Cardiac Troponin Right

2020 ◽  
Author(s):  
Fred S Apple ◽  
Paul O Collinson ◽  
Peter A Kavsak ◽  
Richard Body ◽  
Jordi Ordóñez-Llanos ◽  
...  
Keyword(s):  
Clinical Application ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Clinical Chemistry ◽  
Cardiac Biomarkers ◽  
International Studies ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

Abstract The Committee on the Clinical Application of Cardiac Biomarkers (C-CB) of the International Federation of Clinical Chemistry (IFCC) represents international groups from laboratory medicine, cardiology and emergency medicine involved in providing global educational guidance pertaining to the analytical and clinical applications of cardiac biomarkers. For that reason, most of the members are involved with national and international studies and trials pertaining to high sensitivity (hs) cardiac troponins I and T (cTnI and cTnT) (1-3). Although the recently published ‘2020 European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation’ present some topics very well, the current special report was developed to delineate our specific concerns regarding the ESB guidance for the use of hs-cardiac troponin (hs-cTn) (4).

scholarly journals MODERN METHODS TO DIFFERENTIATE BETWEEN CHEST PAIN AND CARDIAC ISCHEMIA

2020 ◽  
Vol 49 (06) ◽  
pp. 43-43
Author(s):  
Giorgi Javakhishvili ◽  
Rusudan Sujashvili
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Fibrous Cap ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute coronary syndromes include: hypertension, smoking, diabetes, obesity, sedentary life-style, hereditary conditions etc. Chronic stress to the coronary endothelium eventually leads to inflammation and atherosclerotic plaque formation. Plaque at some point with additional stress will rupture and trigger thrombus formation. Probability of plaque rupture depends on its composition: stable plaques contain small fatty core and thick fibrous cap, unstable plaque have larger fatty cores and thin fibrous cap. Patients with acute coronary syndromes present with chest pain and/or discomfort and may experience tightness and pressure sensation; pain may radiate to left or both arms, jaw, back or stomach, sweating, dyspnea and dizziness are also common complaints. Whenever we suspect ACS first diagnostic tests is always ECG (Electrocardiography). If ST segment is persistently elevated STEMI (ST Elevation Myocardial Infarction) can be diagnosed and reperfusion therapy is indicated; but if ST segment is depressed and/or T wave inversion is present laboratory tests are necessary for diagnosis. Cardiac biomarkers mainly used in the clinic are Troponins and CK-MB (Creatine Kinase MB), yet LDH (lactate dehydrogenase), B-type natriuretic peptide and C-reactive protein can be used additionally. Several studies have been conducted in hopes to find other myocardial markers useful for diagnosis of ACS, one of which tested candidate biomarkers such as hFABP (Heart-type fatty acid binding protein), GPBB (Glycogen Phosphorylase Isoenzyme BB), S100, PAPP-A (Pregnancy-associated plasma protein A), TNF (Tumor Necrosis Factor), IL6 (Interleukin 6), IL18 (Interleukin 18), CD40 (Cluster of differentiation 40) ligand, MPO (Myeloperoxidase), MMP9 (Matrix metallopeptidase 9), cell-adhesion molecules, oxidized LDL (Low Density Lipoprotein), glutathione, homocysteine, fibrinogen, and D-dimer, procalcitonin. The idea of this study was to estimate usefulness of combining enzymatic markers with nonenzymatic ones in the clinical settings.

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