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
...D...
...cute Coronary Syndromes The top half...
...2. GRACE Risk Model Nomogram 1. Find...
...sk Scorea for NSTE-ACSTIMI Risk S...
...Clinical Assessment and Initial Evaluation...
...ED or Outpatient Facility Presentat...
...gnosis—Early Risk Stratification Rec...
...le 5. Cardiac Biomarkers and the U...
Treatment
...Treatment...
Table 6. Standard Medical Therapies...
...ble 7. Inhibitors of the Renin-Angiotens...
Table 8. Initial Antiplatelet/Anticoagulant...
...nvasive and Ischemia-Guided Strategies...
...Algorithm for Management of Patients With Definit...
.... Risk Stratification Before Discharge...
...rdial Revascularization Recommendat...
...able 12. Timing of Urgent CABG in Patients With...
...scharge From the ED or Chest Pain Unit...
...able 14. Factors Associated With Appropr...
...able 15. Dosing of Parenteral Antico...
...te Hospital Care, Hospital Discharge, and Posth...
...17. Quality of Care and Outcomes for ACS—...
...l Patient Groups Recommendatio...