Acute coronary syndromes refer to any constellation of clinical symptoms compatible with acute myocardial ischemia which may be life-threatening.
It encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Unstable angina is the ischemic discomfort that presents without persistent ST-segment elevation on ECG and without the presence of cardiac markers in the blood.
Non-ST-segment elevation myocardial infarction is diagnosed if cardiac markers are positive with ST-segment depression or with nonspecific or normal ECGs.
The patient typically presents with ischemic-type chest pain that is severe and prolonged and may occur at rest or may be caused by less exertion than previous episodes.
In the first year following percutaneous coronary intervention for acute coronary syndrome, ticagrelor and prasugrel cuts the risk of gastrointestinal (GI) bleeding by more than 30 percent compared with clopidogrel, as shown in a large real-world study.
Taking ticagrelor alone — and dropping aspirin — after 3 months of DAPT* post-PCI** significantly reduced bleeding events without increasing the risk of ischaemic adverse events compared with continuing a DAPT of ticagrelor plus aspirin, the TICO*** trial has shown.
For patients undergoing CABG*, using a radial artery graft to create the second bypass conduit led to better 10-year survival and cardiovascular outcomes than using a saphenous vein grafting, according to the RADIAL** meta-analysis presented at the recent ACC.20/WCC Virtual Meeting.
Genotype-guided choice of dual antiplatelet therapy just missed significance in reducing ischaemic events in patients with acute coronary syndrome and stable coronary artery disease who underwent percutaneous coronary intervention (PCI), according to the results of the two-arm, parallel, open-label, international, multicentre, randomized superiority TAILOR PCI trial presented at the American College of Cardiology 2020/World Congress of Cardiology (ACC.20/WCC) virtual meeting.
In-hospital initiation of the PCSK9* inhibitor evolocumab, on top of high-intensity statin therapy, in the very high-risk, acute phase of ACS** significantly reduced LDL-C levels — so much so that >95 percent of the patients achieved the recommended target levels — compared with high-intensity statin alone, the EVOPACS*** study has shown.
An edoxaban-based dual antithrombotic therapy (DAT) was noninferior to a VKA*-based triple AT (TAT) in terms of bleeding events at 12 months in patients with atrial fibrillation (AF) following a successful PCI**, without compromising the antithrombotic’s efficacy in preventing ischaemic events, the ENTRUST-AF PCI*** study shows.
The addition of alirocumab to intensive statin therapy appears to cut the risk of death following acute coronary syndrome, especially if treatment is sustained for at least 3 years, if baseline low-density lipoprotein cholesterol (LDL-C) is ≥100 mg/dL or if achieved LDL-C is low, according to data from the ODYSSEY OUTCOMES.
Undergoing primary percutaneous coronary intervention (PCI) through the transradial route did not confer survival benefit at 30 days in patients with acute myocardial infarction compared with the transfemoral approach, contrary to common belief.
Use of the NOAC* apixaban led to less bleeding and hospitalizations compared with vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) who had a recent acute coronary syndrome (ACS) or had undergone percutaneous coronary intervention (PCI) and were on treatment with a P2Y12 inhibitor, reveals the AUGUSTUS study. Furthermore, dropping aspirin from the regimen shields these patients against bleeding risk without significant increase in ischaemic events.