Advertisement

Acute Coronary Syndromes

  • Benjamin Sanchez
Chapter

Abstract

Define acute coronary syndromes. Understand the basic pathophysiology of acute coronary syndromes. Recognize the signs and symptoms of acute coronary syndromes. Identify and evaluate different biomarkers. Risk stratify patients. Know the major treatment strategies for acute coronary syndromes.

Keywords

Percutaneous Coronary Intervention Acute Coronary Syndrome Unstable Angina Mitral Regurgitation Cardiogenic Shock 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    WHO Working Group. The establishment of ischemic heart disease registers (report of fifth working group). Copenhagen: World Health Organization. WHO Reg Publ Eur Ser. 1972;821(suppl 5)Google Scholar
  2. 2.
    Task Force. Task force on standardization of clinical nomenclature. Circulation. 1979;59:607-609.CrossRefGoogle Scholar
  3. 3.
    Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined. J Am Coll Cardiol. 2000;36(3):959-69.PubMedCrossRefGoogle Scholar
  4. 4.
    Ross R, Glomset J, Harker L. Response to injury and atherogenesis. Am J Pathol. 1977;86:657-84.Google Scholar
  5. 5.
    Gordon T, Kannel WB. Multiple risk functions for predicting coronary heart disease: the concept, accuracy, and application. Am Heart J. 1982;103:1031-1039.PubMedCrossRefGoogle Scholar
  6. 6.
    Muller JE, Moreno PR. Definition of the vulnerable plaque. In: Waksman R, Serruys PW, eds. Handbook of the Vulnerable Plaque. London: Taylor & Francis; 2004:1-15.Google Scholar
  7. 7.
    Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109(suppl III):III-27-III-32.CrossRefGoogle Scholar
  8. 8.
    Falk E. Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol. 1989;63:114E-120E.PubMedCrossRefGoogle Scholar
  9. 9.
    Davies MJ, Thomas AC. Plaque fissuring: the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J. 1985;53:363-373.PubMedCrossRefGoogle Scholar
  10. 10.
    Shattil SJ. Platelets and their membranes in hemostasis: physiology and pathophysiology. Ann Intern Med. 1981;94:108.PubMedGoogle Scholar
  11. 11.
    Aukrust P, et al. Enhanced levels of soluble and membrane-bound CD40 ligand in patients with unstable angina: possible reflection of T lymphocyte and platelet involvement in the pathogenesis of acute coronary syndromes. Circulation. 1999;100:614-620.PubMedCrossRefGoogle Scholar
  12. 12.
    Moonsa A et al. Tissue factor and coronary artery disease. Cardiovasc Res. 2002;53:313-325.CrossRefGoogle Scholar
  13. 13.
    Blake G, et al. C-reactive protein and other inflammatory risk markers in acute coronary syndromes. J Am Coll Cardiol. 2003;41(4 suppl S CRP in ACS):37S-42S.PubMedCrossRefGoogle Scholar
  14. 14.
    Bertrand ME. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J. 2000;21:1406-1432.PubMedCrossRefGoogle Scholar
  15. 15.
    Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction – executive summary. J Am Coll Cardiol. 2007;50(7):652-726.CrossRefGoogle Scholar
  16. 16.
    Battler A et al. The initial chest x-ray in acute myocardial infarction: prediction of early and late mortality and survival. Circulation. 1980;61:1004-1009.PubMedCrossRefGoogle Scholar
  17. 17.
    Docherty I, et al. Myoglobin concentration, creatine kinase activity, and creatine kinase b subunit concentrations in serum during thyroid disease. Clin Chem. 1984;30(1):42-45.PubMedGoogle Scholar
  18. 18.
    Gibbons R. The quantification of infarct size. J Am Coll Cardiol. 2004;44:1533-42.PubMedCrossRefGoogle Scholar
  19. 19.
    Ioannidis J, et al. Mortality risk conferred by small elevations of creatine kinase-MB isoenzyme after percutaneous coronary intervention. J Am Coll Cardiol. 2003;42:1406-1411.PubMedCrossRefGoogle Scholar
  20. 20.
    Ellis AK, Saran BR. Kinetics of myoglobin release and prediction of myocardial myoglobin depletion after coronary artery reperfusion. Circulation. 1989;80:676-683.PubMedCrossRefGoogle Scholar
  21. 21.
    Antman EM et al. Cardiac specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335:1342-9.PubMedCrossRefGoogle Scholar
  22. 22.
    Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1-11.PubMedCrossRefGoogle Scholar
  23. 23.
    James SK, Lindahl B, Siegbahn A, et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation. 2003;108:275-81.PubMedCrossRefGoogle Scholar
  24. 24.
    Blake GJ, et.al. C-reactive protein and other inflammatory risk markers in acute coronary syndromes. J Am Coll Cardiol. 2003; 41(4 suppl S):37S-42S.PubMedCrossRefGoogle Scholar
  25. 25.
    Galvani M, Ottani F, Oltrona L, et al. N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes. Circulation. 2004;110: 128-34.PubMedCrossRefGoogle Scholar
  26. 26.
    Slater DK, Hlatky MA, Mark DB, Harrell FEJ, Pryor DB, Califf RM. Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings. Am J Cardiol. 1987;60:766-70.PubMedCrossRefGoogle Scholar
  27. 27.
    Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835-42.PubMedCrossRefGoogle Scholar
  28. 28.
    Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345-53.PubMedCrossRefGoogle Scholar
  29. 29.
    Williams AE, Freeman MR, Chisholm RJ, et al. Angiographic morphology in unstable angina. Am J Cardiol. 1988;62:1024-1027.PubMedCrossRefGoogle Scholar
  30. 30.
    Lewis HDJ, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a Veterans Administration Cooperative Study. N Engl J Med. 1983;309:396-403.PubMedCrossRefGoogle Scholar
  31. 31.
    Schroeder WS, Ghobrial L, Gandhi PJ. Possible mechanisms of drug-induced aspirin and clopidogrel resistance. J Thromb Thrombolysis. 2006;22:139-150.PubMedCrossRefGoogle Scholar
  32. 32.
    Song KH, Fedyk R, Hoover R. Interaction of ACE inhibitors and aspirin in patients with congestive heart failure. Ann Pharmacother. 1999;33:375-7.PubMedCrossRefGoogle Scholar
  33. 33.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502.PubMedCrossRefGoogle Scholar
  34. 34.
    Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long- term therapy in patients undergoing percutaneous coronary intervention: the PCI-CUREstudy. Lancet. 2001;358:527-33.PubMedCrossRefGoogle Scholar
  35. 35.
    Meine TJ, Roe MT, Chen AY, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE quality improvement initiative. Am Heart J. 2005;149:1043-9.PubMedCrossRefGoogle Scholar
  36. 36.
    Viskin S et al. Treatment with beta-adrenergic blocking agents after myocardialinfarction: from randomized trials to clinical practice. J Am Coil Cardiol. 1995;25:1327-1333.CrossRefGoogle Scholar
  37. 37.
    Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335-71.PubMedCrossRefGoogle Scholar
  38. 38.
    The Beta-blocker Pooling Project Research Group. The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomized trials in postinfarction patients. Eur Heart J. 1988; 9:8-16.CrossRefGoogle Scholar
  39. 39.
    Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA. 1982;247:1707-1714.CrossRefGoogle Scholar
  40. 40.
    Opie LH. Pharmacologic options for treatment of ischemic heart disease. In: Smith TW, ed. Cardiovascular Therapeutics: A Companion to Braunwald’s Heart Disease. Philadelphia, PA: W.B. Saunders; 1996:22-57.Google Scholar
  41. 41.
    Furberg CD, Psaty BM, Meyer JV. Nifedipine: Dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92:1326-31.PubMedCrossRefGoogle Scholar
  42. 42.
    ACE Inhibitor Myocardial Infarction Collaborative Group. Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100, 000 patients in randomized trials. Circulation. 1998;97: 2202-2212.CrossRefGoogle Scholar
  43. 43.
    Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349: 1893-906.PubMedCrossRefGoogle Scholar
  44. 44.
    Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-21.PubMedCrossRefGoogle Scholar
  45. 45.
    Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001-9.PubMedCrossRefGoogle Scholar
  46. 46.
    Muhlestein JB, Horne BD, Bair TL, et al. Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol. 2001;87:257-61.PubMedCrossRefGoogle Scholar
  47. 47.
    Theroux P, Waters D, Qiu S, McCans J, de Guise P, Juneau M. Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation. 1993;88:2045-8.PubMedCrossRefGoogle Scholar
  48. 48.
    Fragmin during Instability in Coronary Artery Disease (FRISC) Study Group. Low-molecular-weight heparin during instability in coronary artery disease. Lancet. 1996;347:561-8.Google Scholar
  49. 49.
    The F.R.A.I.S. Study Group. Comparison of two treatment durations (6 days and 14 days) of a low molecular weight heparin with a 6-day treatment of unfractionated heparin in the initial management of unstable angina or non-Q wave myocardial infarction: FRAX.I.S. (FRAxiparine in Ischaemic Syndrome). Eur Heart J. 1999;20:1553-1562.CrossRefGoogle Scholar
  50. 50.
    Cohen M, Demers C, Gurfinkel EP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and safety of subcutaneous enoxaparin in non-Q-wave Coronary Events Study Group. N Engl J Med. 1997;337:447-452.PubMedCrossRefGoogle Scholar
  51. 51.
    The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIa Investigators. Randomized trial of intravenous heparin versus recombinant hirudin for acute coronary syndromes. Circulation. 1994;90:1631-1637.CrossRefGoogle Scholar
  52. 52.
    Antman EM. Should bivalirudin replace heparin during percutaneous coronary interventions? JAMA. 2003;289:903-5.PubMedCrossRefGoogle Scholar
  53. 53.
    Yusuf S, Mehta SR, Chrolavicius S, et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006;354:1464-76.PubMedCrossRefGoogle Scholar
  54. 54.
    The EPIC Investigation. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med. 1994;330:956-61.CrossRefGoogle Scholar
  55. 55.
    The CAPTURE Investigators. Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study (published erratum appears in Lancet. 1997;350:744). Lancet. 1997;349:1429-1435.Google Scholar
  56. 56.
    Simoons ML. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomized trial. Lancet. 2001;357:1915-24.PubMedCrossRefGoogle Scholar
  57. 57.
    The PURSUIT Trial Investigators. Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. Platelet glycoprotein IIb/IIIa in unstable Angina: receptor suppression using integrilin therapy. N Engl J Med. 1998;339:436-43.CrossRefGoogle Scholar
  58. 58.
    Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction (published erratum appears in N Engl J Med. 1998;339:415). N Engl J Med. 1998;338:1488-1497.Google Scholar
  59. 59.
    Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indicationsfor fibrinolytic therapy in suspended acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994;343:311-22.Google Scholar
  60. 60.
    Antman EM et al. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36(3):959-69.PubMedCrossRefGoogle Scholar
  61. 61.
    Hajjar DP, Nicholson AC. Atherosclerosis. Am Sci. 1995;83: 460-467.Google Scholar
  62. 62.
    French JK, White HD. Clinical implications of the new definition of myocardial infarction. Heart. 2004;90:99-106.PubMedCrossRefGoogle Scholar
  63. 63.
    Braunwald E, Mark DB, Jones RH, et al. Unstable Angina: Diagnosis and Management, Clinical Practice Guidelines No. 10. AHCPR Publication No. 94–0602 (May 1994).Google Scholar

Additional Reading

  1. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction – executive summary. J Am Coll Cardiol. 2007;50(7):652-726.CrossRefGoogle Scholar
  2. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol. 2004;44:671-719.PubMedCrossRefGoogle Scholar
  3. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined. J Am Coll Cardiol. 2000;36(3):959-69.PubMedCrossRefGoogle Scholar
  4. Antman EM. The TIMI Risk Score for unstable angina/non–ST elevation MI. A method for prognostication and therapeutic decision making. JAMA. 2000;284:835-842.PubMedCrossRefGoogle Scholar
  5. Braunwald E. Acute myocardial infarction. In: Heart Disease: A Textbook of Cardiovascular Medicine. 5th ed. Philadelphia: W. B. Saunders; 1997. pp. 1184-1288.Google Scholar
  6. Crawford MH, DiMarco JP, Paulus WJ. Acute coronary syndromes. In: Cardiology. 2nd ed. Mosby London, UK; 2004. pp. 311-462.Google Scholar
  7. Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992;326:242-250.PubMedCrossRefGoogle Scholar
  8. Galvani M, Ottani F, Oltrona L, et al. N-terminal pro-brain natruiretic peptide on admission has prognostic valve across the whole spectrum of acute coronary syndromes. Circulation. 2004;110:128-34.PubMedCrossRefGoogle Scholar
  9. The CAPTURE Investigators. Randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study. Lancet. 1997;349(9063): 1429-1435.CrossRefGoogle Scholar
  10. Weitz JI, Buller HR. Direct thrombin inhibitors in acute coronary syndromes: present and future. Circulation. 2002;105:1004-1011.PubMedCrossRefGoogle Scholar
  11. Yusuf S, Zhao F, Mehta SR, et al. The clopidogrel in unstable angina to prevent recurrent events trial investigators: effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7): 494-502.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Benjamin Sanchez
    • 1
  1. 1.Department of CardiologyTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations