Acute coronary syndromes

Abstract

Acute coronary syndromes (ACS) are responsible for over 1.4 million hospital admissions in the USA each year and are associated with considerable mortality. ACS encompasses a group of three related clinical entities: unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). A comprehensive description of the definitions and clinical classification of the diseases will be followed by a review of disease pathophysiology. The role of inflammation, endothelial dysfunction, and plaque vulnerability and rupture are presented. The ability to rapidly and accurately diagnose ACS is paramount to patient care as early initiation of therapy improves outcomes. The diagnostic criteria will be covered including methods of clinical risk stratification. The treatment of ACS has evolved rapidly over the last 10 years, with a focus on achieving timely reperfusion in STEMI and the approval of several new antiplatelet and antithrombin therapies. This chapter will provide a categorized review of medical treatment options and interventional strategies for ACS and guide clinicians in determining appropriate patients for invasive therapies. Additionally, a review of recently published ACS guidelines will be provided.