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
Diagnos...
...gure 1. Acute Coronary SyndromesThe top half of th...
...ure 2. GRACE Risk Model NomogramHaving troub...
...le 1. TIMI Risk Scorea for NSTE-ACSHaving...
...ble 2. Clinical Assessment and Initial Eval...
...3. ED or Outpatient Facility PresentationHaving...
...le 4. Prognosis—Early Risk StratificationHavi...
...able 5. Cardiac Biomarkers and the Universal...
Treatment
...reatment...
.... Standard Medical TherapiesHaving trouble vi...
...7. Inhibitors of the Renin-Angiotensi...
...able 8. Initial Antiplatelet/Anticoagu...
...e 9. Early Invasive and Ischemia-Guided S...
...orithm for Management of Patients Wi...
...0. Risk Stratification Before Discharge for...
...Myocardial RevascularizationHaving tro...
...iming of Urgent CABG in Patients With NSTE-ACS in...
...able 13. Discharge From the ED or Che...
...4. Factors Associated With Appropriate Selection...
...Dosing of Parenteral Anticoagulants During PCIHa...
...able 16. Late Hospital Care, Hospital Discharge, a...
Table 17. Quality of Care and Outcomes for AC...
Table 18. Special Patient GroupsHaving trouble...