Use eptifibatide or tirofiban in patients with high-risk features in whom invasive treatment is not planned.
In the final report of the HORIZONS-AMI trial, which assessed the 3 year outcomes of the effectiveness and safety of bivalirudin monotherapy and paclitaxel-eluting stenting, outcomes were sustained for patients with STEMI undergoing primary PCI.Optimal medical therapies include use of standard medical therapies, including beta blockers, aspirin, and unfractionated heparin or LMWH.Acute Coronary Syndrome covers the spectrum of clinical conditions ranging from unstable angina to non-ST elevation myocardial infarction and ST elevation myocardial.A decrease was reported in 30-day and 1-year mortality that was sustained during long-term follow-up.
Roe MT, Harrington RA, Prosper DM, Pieper KS, Bhatt DL, Lincoff AM, et al.Lev EI, Hasdai D, Scapa E, Tobar A, Assali A, Lahav J, et al.Clinical decisions regarding concomitant use of PPIs and thienopyridines must balance overall risks and benefits, considering both CV and GI complications.This plot shows changes in cardiac markers over time after the onset of symptoms.Distinguish ST-segment elevation (STE) and non-STE acute coronary syndrome.Macrae AR, Kavsak PA, Lustig V, Bhargava R, Vandersluis R, Palomaki GE, et al.
Early and late outcome prediction of death in the emergency room setting by point-of-care and laboratory assays of cardiac troponin I.Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction: Results From the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) Registry.Patients with acute coronary syndrome (ACS) need to be risk stratified to deliver the most appropriate therapy.CARDIOLOGY II Learning Objectives for Acute Coronary Syndromes: Evolving Practices 1.
Before any of these procedures, a doctor must find the blocked part or parts of the coronary arteries.These drugs may prevent mechanical complications of myocardial infarction, including rupture of the papillary muscle, left ventricular free wall, and ventricular septum.A heart-healthy lifestyle can help prevent heart disease, which can lead to acute coronary syndrome.ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
Morphine (or fentanyl) for pain control, oxygen, sublingual or intravenous (IV) nitroglycerin, soluble aspirin 162-325 mg, and clopidogrel with a 300- to 600-mg loading dose are given as initial treatment.
Acute coronary syndrome (ACS) is a term that describes symptoms related to poor blood flow to the heart muscle that lead to a heart attack.Clopidogrel requires metabolic activation by cytochrome P450 2C19 (CYP2C19).Early versus delayed invasive intervention in acute coronary syndromes.In the setting of ongoing symptoms and electrocardiogram (ECG) changes, nitrates titrated to 10% reduction in blood pressure and symptoms, beta blockers, and heparin are all indicated.Aggressive treatment is indicated to prevent worsening of the situation.Fatal and life-threatening bleeding rates were not increased.Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al.Rosenberg S, Elashoff MR, Beineke P, Daniels SE, Wingrove JA, Tingley WG.
A study by Oler et al found that unfractionated heparin was associated with a 33% reduction in the risk of myocardial infarction or death in patients with unstable angina who were treated with aspirin plus heparin, compared with patients who were treated with aspirin alone.Do not administer nitrates if the patient is hypotensive (systolic BP.Another factor Xda inhibitor, fondaparinux (Arixtra), has been studied for use in patients with STEMI who do not undergo PCI.Although 3 LMWHs are approved for use in the United States, only enoxaparin is currently approved for use in unstable angina.
They also decrease mortality and adverse cardiovascular events.Safety of clopidogrel being continued until the time of coronary artery bypass grafting in patients with acute coronary syndrome: a meta-analysis of 34 studies.Iliou MC, Fumeron C, Benoit MO, Tuppin P, Calonge VM, Moatti N, et al.
Usefulness of comprehensive cardiothoracic computed tomography in the evaluation of acute undifferentiated chest discomfort in the emergency department (CAPTURE).An approximately three-fold increase in TIMI minor bleeding events was also seen.Monitor and immediately treat arrhythmias in the first 48 hours.The Acute Coronary Syndromes page contains articles and information from the New England Journal of Medicine.Edward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine.Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease.Percutaneous coronary intervention (PCI) may be required to open a blocked coronary artery.