Acute Coronary Syndromes in Clinical Practice

This functional publication presents a finished evaluation of the epidemiology and medical presentation of acute coronary syndromes (ACS). It additionally courses the reader via chance review, threat stratification, analysis, and remedy of ACS.

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Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335:1342– 1349. 3. 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; 284:835–842. 4. Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.

Intensifying platelet inhibition – navigating between Scylla and Charybdis. N Engl J Med 2007; 357:2078–2081. 22. Chew DP, Bhatt DL, Sapp S, et al. Increased mortality with oral platelet glycoprotein IIb/ IIIa antagonists: a meta-analysis of phase III multicenter randomized trials. Circulation 2001; 103:201–206. 23. Quinn MJ, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa inhibitors: recognition of a twoedged sword? Circulation 2002; 106:379–385. 24. Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes.

Patients with lateral myocardial infarction due to circumflex artery occlusion also deserve special mention since this area can be electrocardiographically silent. Summary The diagnosis of ACS patients is critically important in order to improve cardiac outcomes, including patient survival. The art of medicine and the science of diagnostic studies combine to formulate an accurate diagnosis and assess patient risk. Novel biomarkers are under study that may allow even earlier detection of lower thresholds of myonecrosis, while electrocardiograms with greater than 12 leads are also under investigation for the diagnosis of ACS with even more precision.

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