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Percutaneous Coronary Interventions for NSTEMI and Unstable Angina

  • Stéphane Noble
  • Marco Roffi
Chapter

Abstract

Acute coronary syndromes (ACS) have been traditionally divided into unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Unstable angina is defined by the presence of ischemic symptoms at rest, or at minimal effort in the absence of myocardial injury (i.e., absence of elevation of high-sensitivity cardiac troponins). These patients are at low risk of life-threatening arrhythmias, myocardial infarction (MI), or death. In the absence of recurrent symptoms, continuous rhythm monitoring is not mandatory. Moreover, in UA patients, the benefit of intensive antiplatelet therapy and early revascularization is modest. By definition, NSTEMI is characterized by myocardial injury, which translates into an increased risk of life-threatening arrhythmias and death. These patients derive a benefit from intensive antiplatelet therapy and revascularization. The universal definition of MI requires the presence of typical ischemic symptoms or ischemic ECG changes in addition to a troponin level above the 99th percentile of healthy individuals, with a rise and/or fall of the biomarker. While there are five different types of MI, we focus on type 1 and 2. Type 3 corresponds to MI resulting in death and with no biomarkers available. Type 4 and 5 are MI post-percutaneous coronary intervention and coronary artery bypass grafting, respectively.

Keywords

NSTEMI Unstable angina Acute coronary syndromes Percutaneous coronary intervention Early invasive approach Dual-antiplatelet therapy (DAPT) Prasugrel Ticagrelor Clopidogrel ECMO (ExtraCorporeal Membrane Oxygenation) 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiology DivisionUniversity Hospital of GenevaGenevaSwitzerland

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