Non-ST-Elevation Acute Coronary Syndromes
Key Points
Key Points
- A key branch point is ST elevation or new left bundle-branch block on the ECG, which are considerations for immediate coronary angiography to determine if there is an indication for reperfusion therapy to open a likely completely occluded coronary artery.
- The imbalance may also be caused by other conditions, including excessive myocardial oxygen demand in the setting of a stable flow-limiting lesion; acute coronary insufficiency due to other causes (e.g., vasospastic [Prinzmetal] angina, coronary embolism, coronary arteritis); noncoronary causes of myocardial oxygen supply-demand mismatch (e.g., hypotension, severe anemia, hypertension, tachycardia, hypertrophic cardiomyopathy, severe aortic stenosis); nonischemic myocardial injury (e.g., myocarditis, cardiac contusion, cardiotoxic drugs); and multifactorial causes that are not mutually exclusive (e.g., stress [Takotsubo] cardiomyopathy, pulmonary embolism, severe HF, sepsis).
- If cardiac biomarkers are elevated and the clinical context is appropriate, the patient is considered to have NSTEMI. Otherwise, the patient is deemed to have UA.
- ST depression, transient ST elevation, and/or prominent T-wave inversions may be present but are not required for a diagnosis of NSTEMI.
- Abnormalities on the ECG and elevated troponins in isolation are insufficient to make the diagnosis of ACS but must be interpreted in the appropriate clinical context.
Diagnosis
...agnosis...
...e 1. Acute Coronary SyndromesThe top ha...
...GRACE Risk Model NomogramHaving tr...
Table 1. TIMI Risk Scorea for NSTE-ACSHaving t...
...nical Assessment and Initial EvaluationHa...
...r Outpatient Facility PresentationHaving t...
...e 4. Prognosis—Early Risk StratificationHaving...
...c Biomarkers and the Universal Definition of MIHav...
Treatment
...eatment
...ndard Medical TherapiesHaving trouble viewing tabl...
...nhibitors of the Renin-Angiotensin-Aldoster...
...itial Antiplatelet/Anticoagulant The...
...rly Invasive and Ischemia-Guided StrategiesHav...
...rithm for Management of Patients With Defin...
...0. Risk Stratification Before Discharge...
...rdial RevascularizationHaving trouble viewing...
...le 12. Timing of Urgent CABG in Pat...
...Discharge From the ED or Chest Pain UnitHavi...
Table 14. Factors Associated With Appropri...
Table 15. Dosing of Parenteral Anti...
...16. Late Hospital Care, Hospital Dis...
...ity of Care and Outcomes for ACS—Use of Perfor...
...ble 18. Special Patient GroupsHaving trouble vie...