Non-ST-Elevation Acute Coronary Syndromes
Key Points
Key Points
- A key branch point is ST elevation or new left bundle-branch block on the ECG, which are considerations for immediate coronary angiography to determine if there is an indication for reperfusion therapy to open a likely completely occluded coronary artery.
- The imbalance may also be caused by other conditions, including excessive myocardial oxygen demand in the setting of a stable flow-limiting lesion; acute coronary insufficiency due to other causes (e.g., vasospastic [Prinzmetal] angina, coronary embolism, coronary arteritis); noncoronary causes of myocardial oxygen supply-demand mismatch (e.g., hypotension, severe anemia, hypertension, tachycardia, hypertrophic cardiomyopathy, severe aortic stenosis); nonischemic myocardial injury (e.g., myocarditis, cardiac contusion, cardiotoxic drugs); and multifactorial causes that are not mutually exclusive (e.g., stress [Takotsubo] cardiomyopathy, pulmonary embolism, severe HF, sepsis).
- If cardiac biomarkers are elevated and the clinical context is appropriate, the patient is considered to have NSTEMI. Otherwise, the patient is deemed to have UA.
- ST depression, transient ST elevation, and/or prominent T-wave inversions may be present but are not required for a diagnosis of NSTEMI.
- Abnormalities on the ECG and elevated troponins in isolation are insufficient to make the diagnosis of ACS but must be interpreted in the appropriate clinical context.
Diagnosis
...agnosis...
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...e 2. GRACE Risk Model NomogramHaving trou...
...Risk Scorea for NSTE-ACSHaving trou...
...e 2. Clinical Assessment and Initial E...
...3. ED or Outpatient Facility PresentationHav...
...sis—Early Risk StratificationHaving trouble view...
...iac Biomarkers and the Universal Defin...
Treatment
...reatment...
...le 6. Standard Medical TherapiesHaving trouble vie...
...ors of the Renin-Angiotensin-Aldosterone S...
...able 8. Initial Antiplatelet/Anticoagulant...
...nvasive and Ischemia-Guided StrategiesHaving...
...igure 3. Algorithm for Management of Patients...
...tratification Before Discharge for...
...yocardial RevascularizationHaving trou...
...12. Timing of Urgent CABG in Patients With NST...
...harge From the ED or Chest Pain UnitHaving tr...
.... Factors Associated With Appropriate Sel...
...15. Dosing of Parenteral Anticoagulants During PCI...
...Hospital Care, Hospital Discharge, and Posthospita...
...uality of Care and Outcomes for ACS—Use of Perf...
...Special Patient GroupsHaving trouble...