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 patients with acute coronary syndromes, undergoing a more intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapy during the early disease phase leads to a significant decrease in the risk of long-term major adverse cardiac events (MACEs), according to a study. This benefit is more pronounced for patients with higher baseline and larger reduction in LDL-C levels.
Long-term maintenance monotherapy with clopidogrel is superior to aspirin in reducing the risk of both ischaemic and major bleeding events in patients who had successfully undergone 6–18 months of DAPT* without any clinical event following a percutaneous coronary intervention (PCI), the head-to-head HOST-EXAM** trial has shown.
In patients with non–ST‐segment elevation acute coronary syndrome (ACS), elevated levels of plasma long-chain omega-3 polyunsaturated fatty acids appear to contribute to a lower risk of sudden cardiac death, a study has found.
Administering benzodiazepines during an acute coronary syndrome (ACS) may spell trouble for patients, with a recent study showing that despite rapidly relieving anxiety, the drug can also contribute to increased risk of post-traumatic stress disorder (PTSD) symptoms.
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.
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.