Materiały źródłowe

• #1 Acute Coronary Syndrome (ACS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22910-acute-coronary-syndrome

  Acute coronary syndrome is a medical emergency that requires immediate attention. Prompt treatment is important to ease symptoms and prevent complications. […] Acute coronary syndrome treatment focuses on relieving pain and improving blood flow so your heart can work as well as possible, as quickly as possible. Your healthcare provider recommends treatment based on the specific condition you have. Treatment typically involves a combination of medication and procedures to open your arteries and restore heart function. […] There’s no cure for acute coronary syndrome, but early diagnosis and prompt treatment can protect your heart from further damage and help it work as well as possible. […] The medications you receive depend on your specific condition. In some cases, your provider may give you medication before confirming a diagnosis. Medications may include anticoagulants or blood thinners, like aspirin or heparin, to dissolve clots or prevent them from forming.

• #1 Overview of Acute Coronary Syndromes (ACS) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-acute-coronary-syndromes-acs

  Acute coronary syndromes result from acute obstruction of a coronary artery. […] Treatment is with antiplatelets, anticoagulants, nitrates, beta-blockers, and, for STEMI, emergency reperfusion via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery. […] Treatment, including pharmacologic therapy, is designed to relieve distress, interrupt thrombosis, reverse ischemia, limit infarct size, reduce cardiac workload, and prevent and treat complications. An acute coronary syndrome is a medical emergency; outcome is greatly influenced by rapid diagnosis and treatment. […] Prehospital care: Oxygen, aspirin, and nitrates and triage to an appropriate medical center. […] Pharmacologic therapy: Antiplatelet agents, antianginal drugs, anticoagulants, and in some cases other medications.

• #1 Acute coronary syndrome: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/315332

  This is a medical emergency. Immediate treatment is ordered for acute coronary syndrome. The short-term goals include relieving pain and improving blood flow to help restore heart function as quickly as possible. […] Long-term goals include improving overall heart function, managing risk factors, and lowering the risk of a heart attack. Typical treatment includes a combination of medical drugs and surgical procedures. […] Medications include: Nitroglycerin, Antiplatelet drugs, Beta blockers, Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs), Statins. […] People who call the emergency services may be instructed to take or be given aspirin in the ambulance. If medications fail to alleviate the problems and restore proper blood function, angioplasty and stenting as well as coronary bypass surgery may be necessary. […] With lifestyle changes and the right medication, it is possible to prevent acute coronary syndrome or to treat it and lead a normal life.

• #1 Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy

  https://www.anzcor.org/home/acute-coronary-syndromes/guideline-14-2-acute-coronary-syndromes-initial-medical-therapy/

  This guideline applies to adults. […] This guideline is for use by first responders and health professionals in the prehospital and emergency department setting. […] Supplemental oxygen should only be initiated if the patient has hypoxemia, signs of heart failure, or shock. […] Oxygen saturation monitoring should guide oxygen therapy. […] Nitrates can be used for symptom relief and resolution of ST depression. […] Opioids such as morphine or fentanyl can be used as first-line analgesia for ongoing chest discomfort that is unresponsive to nitrates. […] Aspirin administration is recommended with a loading dose of 300 mg followed by regular dosing at 75 to 150 mg daily. […] ANZCOR suggests anticoagulation with either subcutaneous enoxaparin, intravenous unfractionated heparin (UFH) or other agents in patients with acute coronary syndrome (ACS).

• #1 Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy

  https://www.anzcor.org/home/acute-coronary-syndromes/guideline-14-2-acute-coronary-syndromes-initial-medical-therapy/

  Switching between agents should be avoided. […] There are several therapies in patients with Acute Coronary Syndromes (ACS) that provide relief for symptoms. […] In general, non-steroidal anti-inflammatory drugs (excluding aspirin) should not be administered in patients with suspected ACS as they could be harmful. […] The early administration of aspirin with a loading dose of 300 mg followed by regular dosing at 75 to 150 mg daily is recommended in people with suspected ACS where contraindications such as true anaphylaxis or bleeding disorder have been excluded. […] Ticagrelor is the preferred drug, in conjunction with aspirin, for ACS. […] Clopidogrel is a prodrug with variable response and should only be used for ACS when ticagrelor or prasugrel are unavailable or are precluded by an unacceptably high bleeding risk.

• #1 Updated Guidelines on the Management of Acute Coronary Syndrome – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/news/updated-guidelines-on-the-management-of-acute-coronary-syndrome/

  An updated guideline on the management of acute coronary syndrome has been published by the AHA, ACC, and other organizations. […] Updated guidelines on the management of patients with acute coronary syndrome (ACS) were published in the Journal of the American College of Cardiology and copublished in Circulation. […] Among the most impactful changes in the guideline, the authors recommend that patients with ACS who are not at high risk for bleeding be prescribed dual antiplatelet therapy with aspirin and an oral P2Y12 inhibitor for at least 1 year. […] In patients who are at risk for gastrointestinal bleeding, the authors recommend a proton pump inhibitor. […] Lastly, for patients that need long-term anticoagulation, the authors recommend discontinuation of aspirin 1 to 4 weeks post-PCI in addition to use of a P2Y12 inhibitor.

• #1 Diagnosis and management of acute coronary syndromes – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/diagnosis-and-management-of-acute-coronary-syndromes.html

  After a diagnosis of non-STEMI has been confirmed, acute management includes antiplatelet therapy and anticoagulation, and coronary investigation should be considered. […] Antiplatelet therapy is a cornerstone of acute coronary syndrome management. […] Oral aspirin significantly reduces the risk of recurrent myocardial infarction, strokes and death at 12 months post-myocardial infarction. […] The goal of anticoagulation in acute coronary syndrome is to prevent clot propagation or reformation, in combination with antiplatelet therapy. […] Following acute management of myocardial infarction, secondary prevention strategies should start before the patient leaves hospital.

• #1 Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy

  https://www.anzcor.org/home/acute-coronary-syndromes/guideline-14-2-acute-coronary-syndromes-initial-medical-therapy/

  Prasugrel is one of the preferred antiplatelet options, in addition to aspirin, for ACS. […] In people presenting with NSTEACS, anticoagulation with either subcutaneous enoxaparin, or intravenous unfractionated heparin (UFH) is the preferred treatment strategy. […] In patients with STEMI managed with fibrinolysis, anticoagulation with either enoxaparin or intravenous UFH is reasonable. […] Anticoagulation is recommended in all patients with STEMI, and UFH or enoxaparin are preferred. […] Routine use of glycoprotein (GP) IIb/IIIa inhibitors in the pre-hospital setting increases bleeding risk without improving outcomes, and therefore is not recommended. […] There are several additional medical therapies that have been proposed for ACS patients to reduce myocardial ischaemia and recurrent major cardiovascular events and improve long-term survival.

• #1 The Pharmacist’s Guide to Acute Coronary Syndrome

  https://www.uspharmacist.com/article/the-pharmacists-guide-to-acute-coronary-syndrome

  Anticoagulation therapy plays an important role in managing ACS. STEMI patients undergoing PCI should receive unfractionated heparin titrated to a therapeutic activated clotting time. Bivalirudin may also be used with or without prior treatment with unfractionated heparin and is preferred over unfractionated heparin plus a GP IIb/IIIa antagonist in patients with a high bleeding risk. […] Other routine therapies for patients with ACS are supplemental oxygen, nitroglycerin, IV morphine, beta-blockers, calcium channel blockers, ACE inhibitors, and high-intensity statins. These therapies may be used in patients experiencing STEMI or NSTE-ACS and are given in combination with antiplatelet and anticoagulation therapy. […] After a patient experiences an ACS event, long-term treatment and follow-up are essential to prevent a future event or death. Medications for secondary prevention, including aspirin, ACE inhibitors, statins, beta-blockers, and P2Y12 inhibitors, should be initiated prior to hospital discharge.

• #1 Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy

  https://www.anzcor.org/home/acute-coronary-syndromes/guideline-14-2-acute-coronary-syndromes-initial-medical-therapy/

  Beta-blockers lower heart rate and myocardial contractility, thereby reducing myocardial oxygen consumption, which is useful in the setting of ischemia. […] However, in patients at risk of cardiogenic shock early initiation of beta-blockers pre-hospital or in ED is associated with increased risk of death or shock compared to patients treated later but within 24 hours.

• #1 Medications for Acute Coronary Syndromes – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/medications-for-acute-coronary-syndromes

  For patients receiving a stent for revascularization, aspirin is continued indefinitely. […] Either a low molecular weight heparin (LMWH), unfractionated heparin, or bivalirudin is given routinely to patients with acute coronary syndrome unless contraindicated. […] Patients at high risk of systemic emboli also require long-term therapy with an oral anticoagulant. […] Beta-blockers are recommended unless contraindicated, especially for high-risk patients. […] A short-acting nitrate, nitroglycerin, is used to reduce cardiac workload in selected patients. […] Tenecteplase and reteplase are recommended most often because of their simplicity of administration. […] Angiotensin-converting enzyme (ACE) inhibitors reduce mortality risk in patients with myocardial infarction, especially in those with anterior infarction, heart failure, or tachycardia. […] Statins have long been used for prevention of coronary artery disease and acute coronary syndromes, but there is now increasing evidence that they also have short-term benefits. […] PCSK-9 inhibitors are used for patients not at target low-density lipoprotein cholesterol levels.

• #1 62. Acute Coronary Syndrome

  https://tccc.org.ua/en/guide/acute-coronary-syndrome-cpg

  The routine use of morphine for pain control is not recommended since this has been shown to increase the risk of mortality in ACS. […] Beta blockers should be withheld in patients with systolic blood pressure 100 mmHg, heart rate 60 beats per minute, evidence of pulmonary edema, second or third degree heart block, severe reactive airway disease, or elevated risk of cardiogenic shock. […] It is recommended to avoid transfusion unless the hemoglobin level is 8 g/DL.

• #1 Diagnosis and management of acute coronary syndromes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8671020/

  Acute coronary syndromes are a significant cause of morbidity and mortality in Australia. Outcomes are likely to be improved by rapid and accurate diagnosis, and early intervention. […] Once the diagnosis of acute myocardial infarction has been made, individualised acute reperfusion strategies including percutaneous coronary intervention or fibrinolytic therapy should be considered. Secondary prevention strategies should be implemented before hospital discharge. […] Patients with an ST-elevation myocardial infarction (STEMI) require interventions to re-establish coronary blood flow and minimise morbidity and mortality. This can be achieved by percutaneous coronary intervention or fibrinolytic therapy. […] In the absence of life-limiting comorbidities and contraindications, patients presenting within 12 hours of the onset of chest pain require emergency reperfusion. Primary percutaneous intervention is preferred if it can feasibly be performed within 90 minutes of first medical contact.

• #1 The Pharmacist’s Guide to Acute Coronary Syndrome

  https://www.uspharmacist.com/article/the-pharmacists-guide-to-acute-coronary-syndrome

  NSTE-ACS patients with an elevated mortality risk may also be eligible for early revascularization with PCI or coronary artery bypass graft, whereas those not at high risk may be managed with an ischemia-guided strategy involving delayed PCI or medical management alone. Approximately 32% to 40% of patients with NSTE-ACS undergo PCI. Fibrinolytic therapy is not recommended for NSTE-ACS owing to a lack of data demonstrating benefits for mortality or MI and increased intracranial hemorrhage. […] Regardless of reperfusion strategy, dual antiplatelet therapy and anticoagulation are recommended for treating ACS. A number of antiplatelet and anticoagulant medications are available. Pharmacists can play a key role in medication management and patient counseling, particularly concerning bleeding risk.

• #1 Acute coronary syndrome: risk factors, diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment

  Prior to PCI, patients receive medication to reduce platelet aggregation and thrombosis. This is usually aspirin and a second antiplatelet agent (ticagrelor, prasugrel or clopidogrel), as well as an anticoagulant (heparin). […] Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor (or clopidogrel) should be started on admission to hospital, in combination with fondaparinux, a factor Xa inhibitor, which is given by subcutaneous injection while the patient awaits PCI. […] A small number of patients with ACS may be referred for an urgent coronary artery bypass graft (CABG) in preference to PCI. […] According to the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), cardiac rehabilitation is “the coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patient may, by their efforts, preserve or resume optimal functions in their community and through improved health behaviours, slow or reverse the progression of disease.”

• #1 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  Postmyocardial infarction care should be closely coordinated with the patient’s cardiologist and based on a comprehensive secondary prevention strategy to prevent recurrence, morbidity, and mortality. […] Reperfusion therapy, preferably primary PCI, should be administered to eligible patients with STEMI and symptom onset within the previous 12 hours. […] In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at nonPCI-capable hospitals when the anticipated first medical contact to device time at a PCI-capable hospital exceeds 120 minutes. […] Fibrinolysis is not recommended for treatment in patients with NSTE-ACS. […] Parenteral anticoagulation, in addition to antiplatelet therapy, is recommended for all patients with NSTE-ACS regardless of initial treatment strategy.

• #1 62. Acute Coronary Syndrome

  https://tccc.org.ua/en/guide/acute-coronary-syndrome-cpg

  Aspirin should be administered immediately to all patients with suspected ACS if no contraindications exist. […] Systemic anticoagulation should be administered as soon as the diagnosis of ACS is made if no contraindications exist. […] Prompt reperfusion is the mainstay of STEMI care. Whenever possible, a patient presenting with STEMI should be transferred emergently to the nearest medical facility that can perform urgent PCI as it is considered the optimal treatment. […] Fibrinolytic therapy should be administered within 30 minutes of STEMI diagnosis. […] Regardless of the patients blood lipid levels, high dose Statin therapy should also be administered during the initial presentation (within the first 2 hours) of ACS. […] Administering oxygen in patients with ACS is recommended only when oxygen saturation levels are 90%, to avoid potential harm from oxygen free radicals and further hyperoxia coronary vasoconstriction.

• #1

  https://www.nhs.uk/conditions/heart-attack/treatment/

  You may need to continue taking medicines for some time after PCI. […] If you cannot be treated urgently with PCI, you’ll offered medicines to break down blood clots, known as thrombolytics or fibrinolytics. […] You may still need coronary angiography and PCI once your condition is stable or if thrombolysis does not work. […] If PCI is not suitable for you, you may be treated with 2 types of antiplatelet medicines (usually aspirin and 1 other medicine). […] These medicines make blood flow through your veins more easily. This means your blood will be less likely to form a clot. […] A coronary angioplasty or PCI may not be technically possible if the anatomy of your arteries is different from normal. […] In such circumstances, an alternative operation, known as a coronary artery bypass graft (CABG), may be considered.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/Residency/comments/10jyxwa/acute_coronary_syndrome_for_noobs/

  Regarding antiplatelets, technically for NSTEMI we should be doing DUAL antiplatelet therapy either with ASA + plavix load (CURE), ASA + prasugrel (TRITON-TIMI 38), or ASA + ticagrelor (PLATO) but you will see this will vary from institution to institution. […] IMMEDIATE cath PCI capable facility: door to balloon time 90 mins […] Calculate their TIMI/GRACE score, which is how we usually triage when to cath them Refractory angina, HF or new/worsening MR, hemodynamic instability, VT/VF = immediate invasive strategy (cath within 2 hours) GRACE 140 = early invasive (cath within 24 hours) GRACE 109-140, TIMI 2+ = delayed invasive (cath within 72 hours) GRACE 109, TIMI 0-1 = can consider ischemia-guided (medical management) […] Let me briefly explain cardiac catheterization because I remember not really understanding this as an intern Basically, with the cardiac cath procedure we go up the patient’s femoral artery or radial artery and shoot IV contrast in their coronary arteries to check for blockages If there’s a blockage in 1-2 arteries, we usually place a stent aka PCI HOWEVER, if we see left main coronary artery disease (remember, ST elevation in aVR), 3 vessel disease, or 2 vessel disease including LAD + LV dysfunction we often need to refer these patients to CT surgery for possible CABG.

• #1

  https://www.nhs.uk/conditions/heart-attack/treatment/

  The treatment options for a heart attack depend on whether you’ve had an ST segment elevation myocardial infarction (STEMI), or another type of acute coronary syndrome (NSTEMI or unstable angina). […] An ST segment elevation myocardial infarction (STEMI) requires emergency assessment and treatment. It’s important you’re treated quickly, to minimise damage to your heart after a STEMI. […] If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you’ll be assessed for treatment to unblock your coronary arteries. […] The treatment used will depend on when your symptoms started and how soon you can access treatment. […] If your symptoms started within the past 12 hours you’ll usually be offered a coronary angiography and primary percutaneous coronary intervention (primary PCI).

• #1

  https://www.nhs.uk/conditions/heart-attack/treatment/

  If your symptoms started within the past 12 hours but you cannot access percutaneous coronary intervention (PCI) quickly you’ll be offered medicine to break down blood clots. […] If your symptoms started more than 12 hours ago you may be offered a different procedure, depending on your symptoms. The best course of treatment will be decided after an angiogram and may include medicine, PCI or bypass surgery. […] If a PCI isn’t suitable for you you may be offered a combination of medicines to prevent blood clots, called antiplatelet medicines. […] Primary percutaneous coronary intervention (primary PCI) is an emergency treatment of a STEMI. It’s a procedure to widen any blocked coronary arteries. […] You may also be given blood-thinning medicines to prevent further clots from forming, such as low-dose aspirin.

• #1 Acute Coronary Syndrome (ACS): Causes and Treatment | Doctor

  https://patient.info/doctor/acute-coronary-syndrome-pro

  In lower-risk patients, consider conservative management without early coronary angiography for people with unstable angina or NSTEMI who have a low risk of adverse cardiovascular events (predicted six-month mortality 3.0% or less). […] Important information: Arrange urgent hospital admission (phone 999/112/911). […] Antiplatelet and anticoagulant therapy: In the presence of ischaemic ECG changes or elevation of cardiac troponin, patients with an ACS should be treated immediately with both aspirin (300 mg loading dose) and ticagrelor (180 mg loading dose). […] Glycoprotein IIb/IIIa inhibitors should be considered as an adjunct to PCI for patients at intermediate or higher risk who are not already receiving a glycoprotein inhibitor (GPI). […] Consider coronary angiography (with follow-on PCI if indicated) within 72 hours of first admission for people with unstable angina or NSTEMI who have an intermediate or higher risk of adverse cardiovascular events (predicted six-month mortality above 3.0%) and no contra-indications to angiography (such as active bleeding or comorbidity).

• #1 Medications for Acute Coronary Syndromes – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/medications-for-acute-coronary-syndromes

  Treatment of acute coronary syndromes (ACS) is designed to relieve distress, interrupt thrombosis, reverse ischemia, limit infarct size, reduce cardiac workload, and prevent and treat complications. […] Treatment includes revascularization (with percutaneous coronary intervention, coronary artery bypass grafting, or fibrinolytic therapy) and pharmacologic therapy to treat ACS and underlying coronary artery disease. […] Medications used depend on the type of ACS and include Aspirin, clopidogrel, or both (prasugrel or ticagrelor are alternatives to clopidogrel if fibrinolytic therapy has not been given). […] Fibrinolytics should be used if not contraindicated for STEMI if primary PCI is not immediately available but worsen outcome for unstable angina and non-ST elevation myocardial infarction (NSTEMI).

• #1 Overview of Acute Coronary Syndromes (ACS) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-acute-coronary-syndromes-acs

  Often, reperfusion therapy: Fibrinolytics, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). […] Patients with successful, uncomplicated primary PCI for acute MI may be ambulated quickly and be safely discharged in 2 to 4 days. […] After the acute phase of illness, the most important tasks are often management of depression, rehabilitation, and institution of long-term preventive programs. […] Several medications clearly reduce mortality risk post-MI and are used unless contraindicated or not tolerated: Aspirin and other antiplatelet agents, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins. […] Aspirin and other antiplatelet agents reduce mortality and reinfarction rates in patients after myocardial infarction. […] Beta-blockers are considered standard therapy. […] ACE inhibitors are also considered standard therapy and are given to all post-MI patients if possible, particularly if ejection fraction post MI is 40%. […] Statins are also standard therapy and are routinely prescribed regardless of lipid levels.

• #1 Long-term clinical management after an acute coronary syndrome

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/long-term-clinical-management-after-an-acute-coronary-syndrome

  Even though the approach to successful long-term management is multimodal, this article will focus mainly on four areas: antithrombotic therapy, lipid-lowering therapy, beta-blocker therapy and the role of pharmacological adherence, after an ACS. […] Typically, the standard approach for the majority of patients is dual antiplatelet therapy (DAPT) for at least one year following an ACS episode. […] After the first 12 months, aspirin monotherapy, at a maintenance dose of 75-100 mg o.d., should be used for all patients if no contraindications are present, with a Class I recommendation, Level of Evidence B. […] According to the results of the Dual Antiplatelet Therapy (DAPT) and PrEvention with TRicaGrelor of SecondAry Thrombotic Events in High-RiSk Patients with Prior AcUte Coronary Syndrome-Thrombolysis in Myocardial Infarction Study Group (PEGASUS-TIMI) 54 trials; an extended course of DAPT beyond the first 12 months after an ACS, can be an option in certain types of individuals: patients at high ischaemic risk and without an additional risk of life-threatening or major bleeding events.

• #1 AHA, ACC Update Guidelines for Acute Coronary Syndrome Management

  https://www.ajmc.com/view/aha-acc-update-guidelines-for-acute-coronary-syndrome-management

  The guideline highlights that prompt revascularization remains a Class 1 recommendation and new therapies, such as the microaxial flow pump, may be considered based on patient-specific risks and benefits. […] For patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), the guideline now emphasizes a strategy of complete revascularization rather than just treating the culprit lesion. […] To reduce long-term complications and improve recovery, the guideline includes the following recommendations: Outpatient cardiac rehabilitation referral prior to hospital discharge is strongly recommended to reduce mortality, myocardial infarction recurrence, and hospital readmissions while improving quality of life.

• #1 Acute Coronary Syndrome: Risk Factors, Symptoms & Treatment

  https://www.healthline.com/health/heart-disease/acute-coronary-syndrome

  Adopting health-promoting lifestyle changes is just as important after an ACS event. You can help improve your overall heart health by: eating whole foods and plant-based products; staying physically active; maintaining a moderate weight; quitting smoking if you smoke; managing stress when possible; getting 7 to 9 hours of sleep every night.

• #1 Treatment of Acute Coronary Syndromes in the Elderly and in Patients With Comorbidities – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-treatment-acute-coronary-syndromes-in-articulo-S1885585714001388

  Acute coronary syndromes have a wide spectrum of clinical presentations and risk of adverse outcomes. A distinction should be made between treatable (extent of ischemia, severity of coronary disease and acute hemodynamic deterioration) and untreatable risk (advanced age, prior myocardial damage, chronic kidney dysfunction, other comorbidities). […] In recent years, despite the paucity of specific randomized trials, major advances have been completed in the management of elderly patients and patients with comorbidities: from therapeutic nihilism to careful titration of antithrombotic agents, a shift toward the radial approach to percutaneous coronary interventions, and also to less-invasive cardiac surgery. […] Treatment of ST-segment Elevation Myocardial Infarction: Primary angioplasty (primary percutaneous coronary intervention [pPCI]) has emerged as the most effective and safe reperfusion strategy in elderly patients with STEMI.

• #1 Treatment of Acute Coronary Syndromes in the Elderly and in Patients With Comorbidities – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-treatment-acute-coronary-syndromes-in-articulo-S1885585714001388

  In patients undergoing pPCI, it is reasonable to use bivalirudin rather than unfractionated heparin and a glycoprotein-IIb/IIIa blocker, due to the much lower risk of bleeding. […] In the acute phase of NSTEACS, fondaparinux (2.5 mg once daily) should be the anticoagulant of choice in patients treated conservatively, whereas enoxaparin should be dosed very carefully based on the eGFR. […] Thus, patients with ACS and anemia have an increased prevalence of multiple comorbidities, a high-risk cardiovascular profile, and an overall worse outcome. The complex medical condition of this cohort imposes a great challenge for therapeutic decision-making; specific guidelines with recommended medical treatment and invasive strategies tailored to the various clinical conditions are warranted.

• #1 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  Anticoagulation therapy should also be initiated with either PCI or fibrinolytic therapy for the treatment of STEMI. […] For patients undergoing PCI, unfractionated heparin should be administered to maintain a therapeutic activated clotting time level. […] Additional acute treatment options include supplemental oxygen, nitroglycerin, intravenous morphine, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. […] The key to reducing the risk of morbidity and mortality is a secondary prevention plan, which should be closely coordinated with the patient’s cardiologist. […] Specific recommendations for posthospitalization care include a cardiac rehabilitation program, an evidence-based plan of care that includes medication management and timely follow-up, and strategies to control risk factors, such as cholesterol levels, hypertension, and smoking.

• #2 Acute coronary syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/symptoms-causes/syc-20352136

  Acute coronary syndrome is a term that describes a range of conditions related to sudden reduced blood flow to the heart. […] The goals of treatment are to improve blood flow and treat and prevent complications. […] Acute coronary syndrome usually is caused by a buildup of fatty deposits in and on the walls of the heart’s arteries. […] The lack of oxygen can cause cells in the heart muscle to die. The damage can lead to a heart attack. […] When acute coronary syndrome doesn’t cause heart muscle cells to die, it is called unstable angina.

• #2 Acute coronary syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/diagnosis-treatment/drc-20352140

  The immediate goals of treatment for acute coronary syndrome are to: […] Long-term treatment goals are to: […] Treatment may include medicine and heart procedures or surgery. […] Medicines are given to treat symptoms of acute coronary syndrome and to prevent complications. […] Your healthcare professional may recommend a heart procedure or surgery to restore blood flow to the heart:

• #2 The Pharmacist’s Guide to Acute Coronary Syndrome

  https://www.uspharmacist.com/article/the-pharmacists-guide-to-acute-coronary-syndrome

  Aspirin is the standard of care for all patients presenting with ACS. Its antiplatelet effect is mediated through irreversible inactivation of platelet cyclooxygenase-1, which prevents synthesis of thromboxane A2, a potent agonist of platelet aggregation. Aspirin prevents acute thrombotic occlusion during PCI, reduces the risk of stent thrombosis, and has proven beneficial effects with fibrinolytic therapy. […] A P2Y12 inhibitor should be administered with aspirin in ACS patients in order to provide dual antiplatelet therapy. P2Y12 inhibitors interfere with platelet activation and aggregation by preventing adenosine diphosphate from binding to the P2Y12 platelet receptor site. […] The benefits of dual antiplatelet therapy were first demonstrated in the landmark 2001 trial, Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE).

• #2 Antiplatelet Therapy in Acute Coronary Syndrome | ECR Journal

  https://www.ecrjournal.com/articles/antiplatelet-therapy-acute-coronary-syndrome?language_content_entity=en

  Over recent years, it has become apparent that these drugs may also exert powerful anti-inflammatory effects that provide additional benefit in the management of ACS. […] This review will discuss antiplatelet agents that are currently used to treat patients with UA and MI. […] Current guidelines for the treatment of ACS recommend that all patients routinely receive a loading dose of aspirin, followed by maintenance therapy unless contraindicated. […] In patients who have suffered a MI, recommended secondary prevention therapy typically entails 12 months of dual antiplatelet therapy, followed by lifelong aspirin, whilst patients with angina (stable or unstable) commence aspirin monotherapy. […] Randomised controlled trials have demonstrated that clopidogrel is more effective than aspirin in preventing cardiovascular events in patients with vascular disease, reduces mortality further in patients with MI when used alongside aspirin, and improves outcomes in patients undergoing PCI again when used in combination with aspirin.

• #2 Long-term clinical management after an acute coronary syndrome

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/long-term-clinical-management-after-an-acute-coronary-syndrome

  Even though the approach to successful long-term management is multimodal, this article will focus mainly on four areas: antithrombotic therapy, lipid-lowering therapy, beta-blocker therapy and the role of pharmacological adherence, after an ACS. […] Typically, the standard approach for the majority of patients is dual antiplatelet therapy (DAPT) for at least one year following an ACS episode. […] After the first 12 months, aspirin monotherapy, at a maintenance dose of 75-100 mg o.d., should be used for all patients if no contraindications are present, with a Class I recommendation, Level of Evidence B. […] According to the results of the Dual Antiplatelet Therapy (DAPT) and PrEvention with TRicaGrelor of SecondAry Thrombotic Events in High-RiSk Patients with Prior AcUte Coronary Syndrome-Thrombolysis in Myocardial Infarction Study Group (PEGASUS-TIMI) 54 trials; an extended course of DAPT beyond the first 12 months after an ACS, can be an option in certain types of individuals: patients at high ischaemic risk and without an additional risk of life-threatening or major bleeding events.

• #2 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  Anticoagulation therapy should also be initiated with either PCI or fibrinolytic therapy for the treatment of STEMI. […] For patients undergoing PCI, unfractionated heparin should be administered to maintain a therapeutic activated clotting time level. […] Additional acute treatment options include supplemental oxygen, nitroglycerin, intravenous morphine, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. […] The key to reducing the risk of morbidity and mortality is a secondary prevention plan, which should be closely coordinated with the patient’s cardiologist. […] Specific recommendations for posthospitalization care include a cardiac rehabilitation program, an evidence-based plan of care that includes medication management and timely follow-up, and strategies to control risk factors, such as cholesterol levels, hypertension, and smoking.

• #2 Anticoagulant Therapy for Acute Coronary Syndromes | ICR Journal

  https://www.icrjournal.com/articles/anticoagulant-therapy-acute-coronary-syndromes?language_content_entity=en

  The ESC recommends that anticoagulation with enoxaparin may be used in preference over UFH peri-procedurally in patients with STE-ACS due to undergo PPCI. […] The use of fondaparinux in the context of primary PCI was associated with potential harm in the OASIS 6 trial and is therefore not recommended. […] The use of bivalirudin was tested in 13,819 patients presenting with moderate-to high-risk NSTE-ACS planned for an invasive strategy in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. […] The ESC recommends bivalirudin as an alternative to UFH plus GPIIb/IIIa inhibitors in patients presenting with NSTE-ACS undergoing early invasive revascularisation, particularly if bleeding risks are high. […] The use of anticoagulant therapy is an essential adjunct to antiplatelet therapy in the acute treatment of ACS, and is limited to treatment during initial hospitalisation and revascularisation. […] Large, randomised clinical trials have shown the benefit of fondaparinux as a safer (with similar efficacy) alternative to either LMWH or UFH and it is the anticoagulant of choice on admission.

• #2 Acute Coronary Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459157/

  NSTEMI/Unstable Angina-Symptom control is tried along with the initial treatment with aspirin, and heparin. […] Beta-blockers, statin, and ACE inhibitors should be initiated in all ACS cases as quickly as possible unless contraindications exist. […] Cases not amenable to PCI are taken for CABG (coronary artery bypass graft) or managed medically depending upon comorbidities and patient choice. […] ACS is associated with very high morbidity and mortality and is best managed by an interprofessional team that includes the emergency department physician, cardiologist, internist, pharmacist, and primary caregivers.

• #2 Pharmacologic Management of Post-Acute Coronary Syndrome

  https://www.uspharmacist.com/article/pharmacologic-management-of-post-acute-coronary-syndrome

  The ACC/AHA guidelines recommend clopidogrel 75 mg daily for up to 12 months in combination with aspirin to prevent secondary cardiovascular events in patients who have had ACS. […] ACE inhibitors should be initiated within 24 hours of admission and continued indefinitely in these patients unless systolic blood pressure is less than 100 mmHg or bilateral renal artery stenosis is present. […] The ACC/AHA guidelines recommend indefinite use of beta-blockers to prevent secondary cardiovascular events in patients who have had ACS. […] The ACC/AHA guidelines recommend the use of 1 g/day of omega-3 fatty acids for the secondary prevention of cardiovascular events. […] In summary, the risk of coronary heart disease events such as recurrent MI, stroke, and death are greater for patients with a history of MI and established coronary disease than for patients without known coronary disease; thus, all patients who have had ACS require the administration of antiplatelet, anti-ischemic, and lipid-lowering therapy unless contraindications are present.

• #2 Acute coronary syndrome: risk factors, diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment

  Regardless of the method of reperfusion, it is essential to address lifestyle changes and ensure that medicines are appropriately prescribed to reduce the risk of the patient experiencing subsequent cardiac events. […] DAPT is used for the treatment of MI, but also helps reduce the risk of stent thrombosis. […] An angiotensin converting enzyme (ACE) inhibitor should be prescribed to reduce ventricular remodelling and preserve ventricular function after MI. […] This should also be prescribed to reduce the risk of subsequent MI. […] A high-intensity statin is prescribed to lower total and low-density lipoprotein (LDL) cholesterol and improve plaque stability, thereby reducing risk of subsequent MI or stroke. […] Eplerenone, a mineralocorticoid receptor antagonist, is added when an ECG shows evidence of left ventricular impairment with a reduced ejection fraction (≤40%) in patients who have symptoms of heart failure and/or diabetes.

• #2 Medications for Acute Coronary Syndromes – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/medications-for-acute-coronary-syndromes

  Chest pain can be treated with nitroglycerin or sometimes morphine. […] Blood pressure gradually falls over the next several hours. […] Continued hypertension requires treatment with antihypertensives, preferably IV nitroglycerin, to lower BP and reduce cardiac workload. […] Antiplatelet agents are given aspirin 160 to 325 mg (not enteric-coated), if not contraindicated, at presentation and 81 mg once a day indefinitely thereafter. […] Patients with acute coronary syndrome (ACS) in whom intervention is not possible or recommended are given both aspirin and clopidogrel (or ticagrelor) for at least 12 months. […] In patients undergoing PCI, a loading dose of clopidogrel (300 to 600 mg orally once), prasugrel (60 mg orally once), or ticagrelor (180 mg orally once) improves outcomes.

• #2 62. Acute Coronary Syndrome

  https://tccc.org.ua/en/guide/acute-coronary-syndrome-cpg

  Aspirin should be administered immediately to all patients with suspected ACS if no contraindications exist. […] Systemic anticoagulation should be administered as soon as the diagnosis of ACS is made if no contraindications exist. […] Prompt reperfusion is the mainstay of STEMI care. Whenever possible, a patient presenting with STEMI should be transferred emergently to the nearest medical facility that can perform urgent PCI as it is considered the optimal treatment. […] Fibrinolytic therapy should be administered within 30 minutes of STEMI diagnosis. […] Regardless of the patients blood lipid levels, high dose Statin therapy should also be administered during the initial presentation (within the first 2 hours) of ACS. […] Administering oxygen in patients with ACS is recommended only when oxygen saturation levels are 90%, to avoid potential harm from oxygen free radicals and further hyperoxia coronary vasoconstriction.

• #2 The Pharmacist’s Guide to Acute Coronary Syndrome

  https://www.uspharmacist.com/article/the-pharmacists-guide-to-acute-coronary-syndrome

  Treatment for ACS is time sensitive, multifaceted, and dependent on a specific diagnosis. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed several practice guidelines for treatment and secondary prevention of ACS. These guidelines, which form the basis of this review, should be consulted for more detailed information. […] Quick reestablishment of coronary perfusion is the cornerstone of STEMI treatment. Reperfusion, which may be achieved via mechanical (e.g., primary percutaneous coronary intervention [PCI]) or pharmacologic (e.g., fibrinolytic) means, should be administered to all eligible STEMI patients who have experienced ischemic symptoms for more than 12 hours. Primary PCI of the affected area within 90 minutes of hospital arrival is preferred over fibrinolytic therapy when time to treatment delay is short and the hospital is capable of performing PCI.

• #2 Acute Coronary Syndrome (ACS): Causes and Treatment | Doctor

  https://patient.info/doctor/acute-coronary-syndrome-pro

  Acute coronary syndrome (ACS) is a medical emergency and requires immediate hospital admission. […] Treatment includes antithrombotic treatment, as well as coronary angiography followed by revascularisation if appropriate. The treatment of patients with NSTE-ACS is directed to alleviate pain and anxiety, prevent recurrences of ischaemia and prevent or limit progression to acute myocardial infarction. […] Compared to a conservative strategy, an invasive strategy (PCI or CABG surgery) is associated with reduced rates of refractory angina and rehospitalisation in the shorter term and myocardial infarction in the longer term. An invasive strategy is associated with a doubled risk of procedure-related heart attack and increased risk of bleeding and procedural biomarker leaks. […] Available evidence suggests that an invasive strategy may be particularly useful in those at high risk for recurrent events.

• #2 The Pharmacist’s Guide to Acute Coronary Syndrome

  https://www.uspharmacist.com/article/the-pharmacists-guide-to-acute-coronary-syndrome

  NSTE-ACS patients with an elevated mortality risk may also be eligible for early revascularization with PCI or coronary artery bypass graft, whereas those not at high risk may be managed with an ischemia-guided strategy involving delayed PCI or medical management alone. Approximately 32% to 40% of patients with NSTE-ACS undergo PCI. Fibrinolytic therapy is not recommended for NSTE-ACS owing to a lack of data demonstrating benefits for mortality or MI and increased intracranial hemorrhage. […] Regardless of reperfusion strategy, dual antiplatelet therapy and anticoagulation are recommended for treating ACS. A number of antiplatelet and anticoagulant medications are available. Pharmacists can play a key role in medication management and patient counseling, particularly concerning bleeding risk.

• #2 Medications for Acute Coronary Syndromes – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/medications-for-acute-coronary-syndromes

  For patients receiving a stent for revascularization, aspirin is continued indefinitely. […] Either a low molecular weight heparin (LMWH), unfractionated heparin, or bivalirudin is given routinely to patients with acute coronary syndrome unless contraindicated. […] Patients at high risk of systemic emboli also require long-term therapy with an oral anticoagulant. […] Beta-blockers are recommended unless contraindicated, especially for high-risk patients. […] A short-acting nitrate, nitroglycerin, is used to reduce cardiac workload in selected patients. […] Tenecteplase and reteplase are recommended most often because of their simplicity of administration. […] Angiotensin-converting enzyme (ACE) inhibitors reduce mortality risk in patients with myocardial infarction, especially in those with anterior infarction, heart failure, or tachycardia. […] Statins have long been used for prevention of coronary artery disease and acute coronary syndromes, but there is now increasing evidence that they also have short-term benefits. […] PCSK-9 inhibitors are used for patients not at target low-density lipoprotein cholesterol levels.

• #2 Acute coronary syndrome: risk factors, diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment

  Prior to PCI, patients receive medication to reduce platelet aggregation and thrombosis. This is usually aspirin and a second antiplatelet agent (ticagrelor, prasugrel or clopidogrel), as well as an anticoagulant (heparin). […] Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor (or clopidogrel) should be started on admission to hospital, in combination with fondaparinux, a factor Xa inhibitor, which is given by subcutaneous injection while the patient awaits PCI. […] A small number of patients with ACS may be referred for an urgent coronary artery bypass graft (CABG) in preference to PCI. […] According to the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), cardiac rehabilitation is “the coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patient may, by their efforts, preserve or resume optimal functions in their community and through improved health behaviours, slow or reverse the progression of disease.”

• #2

  https://www.nhs.uk/conditions/heart-attack/treatment/

  The treatment options for a heart attack depend on whether you’ve had an ST segment elevation myocardial infarction (STEMI), or another type of acute coronary syndrome (NSTEMI or unstable angina). […] An ST segment elevation myocardial infarction (STEMI) requires emergency assessment and treatment. It’s important you’re treated quickly, to minimise damage to your heart after a STEMI. […] If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you’ll be assessed for treatment to unblock your coronary arteries. […] The treatment used will depend on when your symptoms started and how soon you can access treatment. […] If your symptoms started within the past 12 hours you’ll usually be offered a coronary angiography and primary percutaneous coronary intervention (primary PCI).

• #2 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  Postmyocardial infarction care should be closely coordinated with the patient’s cardiologist and based on a comprehensive secondary prevention strategy to prevent recurrence, morbidity, and mortality. […] Reperfusion therapy, preferably primary PCI, should be administered to eligible patients with STEMI and symptom onset within the previous 12 hours. […] In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at nonPCI-capable hospitals when the anticipated first medical contact to device time at a PCI-capable hospital exceeds 120 minutes. […] Fibrinolysis is not recommended for treatment in patients with NSTE-ACS. […] Parenteral anticoagulation, in addition to antiplatelet therapy, is recommended for all patients with NSTE-ACS regardless of initial treatment strategy.

• #2 Updated Guidelines on the Management of Acute Coronary Syndrome – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/news/updated-guidelines-on-the-management-of-acute-coronary-syndrome/

  An updated guideline on the management of acute coronary syndrome has been published by the AHA, ACC, and other organizations. […] Updated guidelines on the management of patients with acute coronary syndrome (ACS) were published in the Journal of the American College of Cardiology and copublished in Circulation. […] Among the most impactful changes in the guideline, the authors recommend that patients with ACS who are not at high risk for bleeding be prescribed dual antiplatelet therapy with aspirin and an oral P2Y12 inhibitor for at least 1 year. […] In patients who are at risk for gastrointestinal bleeding, the authors recommend a proton pump inhibitor. […] Lastly, for patients that need long-term anticoagulation, the authors recommend discontinuation of aspirin 1 to 4 weeks post-PCI in addition to use of a P2Y12 inhibitor.

• #2 Acute coronary syndrome: risk factors, diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment

  Sublingual glyceryl trinitrate should be issued on hospital discharge, ensuring that the patient understands how and when this should be used. […] Patients who are at an increased risk of bleeding who are prescribed DAPT or a DAPT/anticoagulation combination will also require a proton-pump inhibitor.

• #2 Treatment of Acute Coronary Syndromes in the Elderly and in Patients With Comorbidities – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-treatment-acute-coronary-syndromes-in-articulo-S1885585714001388

  Treatment of NonST-segment Elevation Acute Coronary Syndrome: Patients with nonST-segment elevation acute coronary syndrome are older than those with STEMI and include more women. […] An early invasive strategy is recommended in diabetic patients with NSTEACS. […] Antithrombotic therapy is the mainstay of ACS management, both in patients managed invasively and in those treated conservatively. […] The risk of gastroenteric bleeding with even low-dose acetylsalicylic acid increases with age and previous history of peptic ulcer; therefore, administration of a proton pump inhibitor is recommended in these patients. […] In elderly patients who are candidates to fibrinolytic therapy, the use of half-dose weight-adjusted tenecteplase is recommended, combined with enoxaparin at the dosage of 0.75mg/kg without the initial intravenous bolus, and followed by clopidogrel (75 mg) with no loading dose.

• #2 Diagnosis and management of acute coronary syndromes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8671020/

  After a diagnosis of non-STEMI has been confirmed, acute management includes antiplatelet therapy and anticoagulation, and coronary investigation should be considered. […] In addition to reperfusion, drug therapy improves the outcomes of acute coronary syndrome. […] Antiplatelet therapy is a cornerstone of acute coronary syndrome management. […] The goal of anticoagulation in acute coronary syndrome is to prevent clot propagation or reformation, in combination with antiplatelet therapy. […] Following acute management of myocardial infarction, secondary prevention strategies should start before the patient leaves hospital.

• #3 Diagnosis and management of acute coronary syndromes – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/diagnosis-and-management-of-acute-coronary-syndromes.html

  After a diagnosis of non-STEMI has been confirmed, acute management includes antiplatelet therapy and anticoagulation, and coronary investigation should be considered. […] Antiplatelet therapy is a cornerstone of acute coronary syndrome management. […] Oral aspirin significantly reduces the risk of recurrent myocardial infarction, strokes and death at 12 months post-myocardial infarction. […] The goal of anticoagulation in acute coronary syndrome is to prevent clot propagation or reformation, in combination with antiplatelet therapy. […] Following acute management of myocardial infarction, secondary prevention strategies should start before the patient leaves hospital.

• #3 Updated Guidelines on the Management of Acute Coronary Syndrome – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/news/updated-guidelines-on-the-management-of-acute-coronary-syndrome/

  An updated guideline on the management of acute coronary syndrome has been published by the AHA, ACC, and other organizations. […] Updated guidelines on the management of patients with acute coronary syndrome (ACS) were published in the Journal of the American College of Cardiology and copublished in Circulation. […] Among the most impactful changes in the guideline, the authors recommend that patients with ACS who are not at high risk for bleeding be prescribed dual antiplatelet therapy with aspirin and an oral P2Y12 inhibitor for at least 1 year. […] In patients who are at risk for gastrointestinal bleeding, the authors recommend a proton pump inhibitor. […] Lastly, for patients that need long-term anticoagulation, the authors recommend discontinuation of aspirin 1 to 4 weeks post-PCI in addition to use of a P2Y12 inhibitor.

• #3 Long-term clinical management after an acute coronary syndrome

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/long-term-clinical-management-after-an-acute-coronary-syndrome

  Beta-blockers are recommended in patients with LVEF 40% after an acute coronary syndrome, regardless of heart failure symptoms. […] A polypill strategy should be considered to improve adherence and cardiovascular outcomes after an acute coronary syndrome. […] Secondary prevention after an acute coronary syndrome (ACS) is key to improving quality of life (QOL) as well as to diminishing morbidity and mortality rates. […] In order for these changes to be implemented by the patient, an outpatient clinical appointment should be arranged, so as to review the patients objectives and preferences, as well as to review the management of the different comorbidities they may suffer from. […] According to the 2023 ESC Guidelines for the management of acute coronary syndromes, treatment goals can be divided into 3 subgroups: Continuation of optimal medical therapy, including annual influenza vaccination, promoting medication adherence, lipid-lowering therapy and antithrombotic therapy.

• #3 Acute coronary syndrome (ACS) trials – CardiologyTrials.org

  http://cardiologytrials.org/acs/

  Beta-blockers improve mortality (ISIS-1) but caution is needed in first 24 hours (COMMIT). […] ACE inhibitors improve mortality after ACS (ISIS-4, GISSI-3), and Aldosterone antagonists are beneficial where LVF/CCF is present (EPHESUS). […] PCI for STEMI is superior to thrombolysis, even when performed routinely after thrombolysis (NORDISTEMI). […] PCI is also beneficial in NSTEMI patients (TACTICS-TIMI-18, RITA-3). […] Statins reduce recurrent cardiovascular events, with a trend emerging as early as 30 days (PROVE-IT).

• #3 Acute Coronary Syndrome: Heart Symptoms in the 3 Types

  https://www.verywellhealth.com/acute-coronary-syndrome-8346870

  The most common treatment for acute coronary syndrome is coronary angioplasty with stent insertion, also known as percutaneous coronary intervention or PCI. During this minimally invasive procedure, a tiny balloon is inflated to widen narrow or blocked arteries. Then, a small wire mesh tube is inserted to keep blood flowing through the reopened artery. It is typically done as emergency surgery. […] When someone has a heart attack, marked by a complete blockage of a major coronary artery, it is recommended that primary PCI is performed within less than 90 minutes of the patient making contact with the EMTs who bring them to the hospital via ambulance. […] Long-term treatment and lifestyle changes are essential for preventing another cardiac event after experiencing an acute coronary syndrome event and being treated at the hospital. Common medications prescribed for secondary prevention of acute coronary syndrome after hospital discharge include: Aspirin, Angiotensin-converting enzyme (ACE) inhibitors, Statins, Beta-blockers, P2Y12 inhibitors. […] In addition to taking medication, staying physically active, eating a heart-healthy diet, stress relief, and getting high-quality sleep in an optimal sleeping environment can all lower the risk of having future acute coronary syndrome symptoms or complications.

• #3 STEMI Management SID • LITFL • CCC Cardiology

  https://litfl.com/stemi-management/

  STEMI is a type of acute coronary syndrome that requires emergency reperfusion therapy. […] All patients must be triaged to a monitored resuscitation bay. […] Opioid analgesia is preferred to nitrates for the initial control of pain in the setting of STEMI. […] In STEMI give: Aspirin 300 mg po then 100-150 mg daily thereafter. […] Dual antiplatelet therapy (i.e. with aspirin and a P2Y12 inhibitor (clopidogrel or ticagrelor) should be prescribed for up to 12 months in patients with confirmed ACS, regardless of whether coronary revascularisation was performed. […] The ideal treatment for all STEMIs is acute PCI or in some cases emergency CABGs. […] Primary PCI is preferred for reperfusion therapy in patients with STEMI if it can be performed within 90 minutes of first medical contact. […] If there are absolute contra-indications to thrombolysis, PCI remains the only option. […] Following discharge, attendance at cardiac rehabilitation or undertaking a structured secondary prevention service is recommended for all patients hospitalized with ACS.

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