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Myocardial infarct size vs duration of coronary occlusion in dogs. The wavefront phenomenon of ischemic cell death. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. Comparison of long-term mortality of acute ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients after percutaneous coronary intervention. Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: a meta-analysis. ![]() Association between hospital process performance and outcomes among patients with acute coronary syndromes. Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, et al. Predictors of one-year mortality at hospital discharge after acute coronary syndromes: a new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study. Pocock S, Bueno H, Licour M, Medina J, Zhang L, Annemans L, et al. Trends in incidence, severity, and outcome of hospitalized myocardial infarction. Roger VL, Weston SA, Gerber Y, Killian JM, Dunlay SM, Jaffe AS, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, et al. Papers of particular interest, published recently, have been highlighted as: The definition of “early” in the early invasive strategy has evolved over the past decade and currently pertains to an invasive strategy performed within 12–24 h of presentation. In higher-risk patients, there is a benefit for a more aggressive approach. We know that the early invasive strategy at least is safe and improves recurrent ischemia and refractory angina as well as the length of stay, lowering the cost. The picture is now a little clearer, but still much remains to be answered. The relatively recent guidelines and meta-analyses on the subject try to shed light on the issue of timing. This paper aims to discuss the importance of timeliness of invasive strategy in the treatment of NSTE-ACS as well as the state-of-the-art approach to this critical health problem. Despite improvements in the systems of care and interventional techniques, the mortality of NSTE-ACS patients remains high, and delays in the treatment of NSTE-ACS patients continue to be a problem. Most NSTE-ACS patients receive invasive therapies. 2014 64(24):e139-228.Non-ST segment elevation acute coronary syndromes (NSTE-ACS) account for 70% of the patients with ACS. 2014 AHA/ACC guideline for the management of non-ST-elevation acute coronary syndromes. Prasugrel is an appropriate P2Y12 inhibitor option for patients following percutaneous coronary intervention with stent placement.Īll patients with NSTE-ACS should be referred to an outpatient comprehensive cardiovascular rehabilitation program.Ĭitation: Amsterdam EA, Wenger NK, Brindis RG, et al. ischemia-guided), post-discharge dual antiplatelet therapy (clopidogrel or ticagrelor) is recommended for up to 12 months in all patients with NSTE-ACS. Regardless of angiography strategy (invasive vs. ![]() Patients managed with an ischemia-guided strategy should undergo pre-discharge noninvasive stress testing for further risk stratification. thrombolysis in myocardial infarction risk score 0 or 1, GRACE score <109, low-risk troponin-negative females). “Ischemia-guided” strategy replaces the term “conservative management strategy,” and its focus on aggressive medical therapy is an option in selected low-risk patient populations (e.g. Initial hospital care for all patients with NSTE-ACS should include early initiation of beta-blockers (within the first 24 hours), high-intensity statin therapy, P2Y12 inhibitor (clopidogrel or ticagrelor) plus aspirin, and parenteral anticoagulation.Īn early invasive strategy (diagnostic angiography within 24 hours with intent to perform revascularization based on coronary anatomy) is preferred to an ischemia-guided strategy, particularly in high-risk NSTE-ACS patients (Global Registry of Acute Coronary Events score >140). When contemporary troponin assays are used for diagnosis, other biomarkers (CK-MB, myoglobin) are not useful. Synopsis: This guideline provides recommendations for acute and long-term care of patients with NSTE-ACS.Ĭardiac-specific troponin assays (troponin I or T) are the mainstay for ACS diagnosis. Clinical question: What is the recommended approach for management of non-ST-elevation acute coronary syndrome (NSTE-ACS)?īackground: This is the first comprehensive update from the American Heart Association/American College of Cardiology (AHA/ACC) on NSTE-ACS since 2007 and follows a focused update published in 2012.
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