acute%20coronary%20syndromes%20w_out%20persistent%20st-segment%20elevation
ACUTE CORONARY SYNDROMES W/OUT PERSISTENT ST-SEGMENT ELEVATION
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.
  1. Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society and International Association for the Study of Obesity. Circulation. 2009 Oct;120(16):1640-1645. http://www.circ.ahajournals.org/. doi: 10.1161/CIRCULATIONAHA.109.192644. Accessed 22 Jun 2011. PMID: 19805654
  2. Anderson JL, Adams CD, Hochman JS, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2007 Aug;50(7):e1-e157. PMID: 17692738
  3. American Heart Association. Part 8: Stabilization of the patient with acute coronary syndromes. Circulation. 2005 Nov;112:IV-89-IV-110.
  4. Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis. 2010 Feb;10(2):83-92. doi: 10.1016/S1473-3099(09)70331-7. PMID: 20113977
  5. Braunwald E. Application of current guidelines to the management of unstable angina and non-ST-elevation myocardial infarction. Circulation. 2003 Oct;108(16)(Suppl 1):III28-37. PMID: 14605017
  6. Bertrand ME, Simoons ML, Fox KA, et al; Task Force on the Management of Acute Coronary Syndromes of the European Society of Cardiology. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002 Dec;23(23):1809-1840. Accessed 16 May 2011. PMID: 12503543
  7. Hamm CW, Bassand JP, Agewall S, et al, The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2011 Dec;32(23):2999-3054. PMID: 21873419
  8. Jneid H, Anderson JL, Wright RS, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J AM Coll Cardiol. 2012 Aug;60(7):645-681. doi: 10.1016/j.jacc.2012.06.004. PMID: 22809746
  9. Harrington RA, Becker RC, Cannon CP, et al. Antithrombotic therapy for non-ST-segment elevation acute coronary syndromes: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(Suppl 6):670S-707S. doi: 10.1378/chest.08-0691. PMID: 18574276
  10. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, Kolh P, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010 Oct;31(20):2501-2555. http://eurheartj.oxfordjournals.org/. doi: 10.1093/eurheartj/ehq277. Accessed 21 Jun 2011. PMID: 20802248
  11. Kushner FG, Hand M, Smith SC Jr, et al. 2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec;120(22):2271-2306. doi: 10.1161/CIRCULATIONAHA.109.192663. PMID: 19923169
  12. O'Connor RE, Brady W, Brooks SC, et al. Part 10: acute coronary syndromes: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010 Nov;122(18)(Suppl 3):S787-S817. http://www.circ.ahajournals.org/. doi: 10.1161/CIRCULATIONAHA.110.971028. PMID: 20956226
  13. McCann CJ, Glover BM, Menown IB, et al. Prognostic value of a multimarker approach for patients presenting to hospital with acute chest pain. Am J Cardiol. 2009 Jan;103(1):22-28. doi: 10.1016/j.amjcard.2008.08.026. PMID: 19101224
  14. Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010 Aug;31:2197-2206. http://eurheartj.oxfordjournals.org/. doi: 10.1093/eurheartj/ehq251. Accessed 03 Aug 2010. PMID: 20685679
  15. Wiviott SD, Braunwald E, McCabe CH, et al; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007 Nov;357(20):2001-2015. PMID: 17982182
  16. Braunwald E, Zipes DP, Libby P. Unstable angina. Heart disease: a textbook of cardiovascular medicine. 6th ed. Philadelphia: W.B. Saunders Company; 2001:1232-1255
  17. MedWormhttp://www.medworm.com/rss/index.php/Cardiology/7/http://www.medworm.com/rss/medicalfeeds/specialities/Cardiology.xml
  18. Spinler S. Evolution of Antithrombotic therapy used in acute coronary syndromes. Cardiology. http://www.circ.ahajournals.org. Accessed 09 Oct 2012.
  19. Ministry of Health Malaysia, National Heart Association of Malaysia, Academy of Medicine Malaysia. Clinical practice guidelines on management of unstable angina/non ST elevation myocardial infarction (UA/NSTEMI). Academy of Medicine of Malaysia. http://www.moh.gov.my/. 2012.
  20. MedWorm - Coronary Heart Diseasehttp://www.medworm.com/rss/medicalfeeds/conditions/Coronary-Heart-Disease-News.xml
  21. Philippine Heart Association CAD Guidelines Writing Committee. 2014 PHA Clinical practice guidelines for the diagnosis and management of patients with coronary artery disease. Philippine Heart Association web site. http://www.philheart.org/. 27 Nov 2014. Accessed 16 Feb 2015.
  22. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J AM Coll Cardiol. 2014;64(24):e139-e228. doi: 10.1016/j.jacc.2014.09.017. Accessed 16 Apr 2015. PMID: 25260718
  23. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267-315. doi: 10.1093/eurheartj/ehv320. PMID: 26320110
  24. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI). Pedoman Tatalaksana Sindrom Koroner Akut. Edisi Ketiga. Jakarta; 2014.
  25. Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov;132(18)(Suppl 2):S414-S435. doi: 10.1161/CIR.0000000000000259. Accessed 06 Jun 2016. PMID: 26472993
  26. Levine GN, Bates ER, Bittl JA, et al; Focused Update Writing Group. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016 Mar 23:pii: S0735-1097(16)01699-5. doi: 10.1016/j.jacc.2016.03.513. PMID: 27036918
  27. Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2017 Feb;69(5):570-591. doi: 10.1016/j.jacc.2016.10.034. PMID: 28012615
  28. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation – web addenda: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Society of Cardiology. https://www.escardio.org/. 2015.
  29. Tan JWC, Lam CSP, Kasim SS, et al. Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI. Heart Asia. 2017;9(1):81-87. doi: 10.1136/heartasia-2016-010818.
  30. Rodriguez F, Mahaffey KW. Management of patients with NSTE-ACS: a comparison of the recent AHA/ACC and ESC guidelines. J Am Coll Cardiol. 2016 Jul 19;68(3):313-21. doi: 10.1016/j.jacc.2016.03.599. PMID: 27417010
  31. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017 Nov 7:pii: S0735-1097(17)41519-1. doi: 10.1016/j.jacc.2017.11.006. Accessed 16 Nov 2017. PMID: 29146535
  32. Valgimigli M, Bueno H, Byrne RA, et al; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14;39(3):213-260. doi: 10.1093/eurheartj/ehx419. Accessed 15 Jan 2018. PMID: 28886622
  33. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators, Yusuf S, Mehta SR, et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006 Apr 6;354(14):1464-1476. PMID: 16537663
  34. Ministry of Health Malaysia, Academy of Medicine Malaysia, National Heart Association of Malaysia. Clinical practice guidelines of stable coronary artery disease 2018. 2nd edition. Academy of Medicine of Malaysia website. http://www.acadmed.org.my. Accessed 29 Jan 2019.
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