When I have acute coronary syndrome, treat me gingerly

Acute coronary syndromes (ACS) map be defined as clinical symptoms or signs of prolonged or accelerating myocardial ischaemia. These conditions are caused by disruption of the atherosclerotic plaque followed by thrombus formation, and are increasingly treated by promoting vessel patency and plaque healing to prevent new episodes of thrombosis. Patients with ST-segment elevation should undergo interventional treatment quickly, however, in patients with non-ST-segment elevation, it is unclear whether an aggressive or a conservative approach to treatment will lead to the better outcome. An inspection of studies in ACS patients evaluating medical and interventional strategies showed that patients with non-ST-segment elevation often had a higher number of cardiovascular events following revascularization and had a better outcome with conservative management. It is therefore proposed that risk stratification, employing clinical evaluation, electrocardiogram and serum markers of myocardial necrosis, should be used to determine the appropriate treatment strategy. Treatment with aspirin, low molecular weight heparin and a glycoprotein (GP) IIb/IIIa inhibitor, in addition to a beta-blocker and nitrates is recommended for all patients. If there is evidence of heart failure or refractory ischaemia, treatment should be aggressive with early angiography; otherwise, patients should be monitored non-invasively for signs or symptoms that indicate progression to an aggressive approach.

Duke Scholars

Author Robert M. Califf Medicine, Cardiology