scholarly journals Questions and answers on antithrombotic therapy and revascularization strategies in non-ST-elevation acute coronary syndrome (NSTE-ACS): a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2020 ◽  
Author(s):  
Emanuele Barbato ◽  
Julinda Mehilli ◽  
Dirk Sibbing ◽  
George C M Siontis ◽  
Jean-Philippe Collet ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antithrombotic Therapy ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Questions And Answers ◽  
Coronary Syndromes ◽  
Esc Guidelines ◽  
St Elevation

scholarly journals MODERN METHODS TO DIFFERENTIATE BETWEEN CHEST PAIN AND CARDIAC ISCHEMIA

2020 ◽  
Vol 49 (06) ◽  
pp. 43-43
Author(s):  
Giorgi Javakhishvili ◽  
Rusudan Sujashvili
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Fibrous Cap ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute coronary syndromes include: hypertension, smoking, diabetes, obesity, sedentary life-style, hereditary conditions etc. Chronic stress to the coronary endothelium eventually leads to inflammation and atherosclerotic plaque formation. Plaque at some point with additional stress will rupture and trigger thrombus formation. Probability of plaque rupture depends on its composition: stable plaques contain small fatty core and thick fibrous cap, unstable plaque have larger fatty cores and thin fibrous cap. Patients with acute coronary syndromes present with chest pain and/or discomfort and may experience tightness and pressure sensation; pain may radiate to left or both arms, jaw, back or stomach, sweating, dyspnea and dizziness are also common complaints. Whenever we suspect ACS first diagnostic tests is always ECG (Electrocardiography). If ST segment is persistently elevated STEMI (ST Elevation Myocardial Infarction) can be diagnosed and reperfusion therapy is indicated; but if ST segment is depressed and/or T wave inversion is present laboratory tests are necessary for diagnosis. Cardiac biomarkers mainly used in the clinic are Troponins and CK-MB (Creatine Kinase MB), yet LDH (lactate dehydrogenase), B-type natriuretic peptide and C-reactive protein can be used additionally. Several studies have been conducted in hopes to find other myocardial markers useful for diagnosis of ACS, one of which tested candidate biomarkers such as hFABP (Heart-type fatty acid binding protein), GPBB (Glycogen Phosphorylase Isoenzyme BB), S100, PAPP-A (Pregnancy-associated plasma protein A), TNF (Tumor Necrosis Factor), IL6 (Interleukin 6), IL18 (Interleukin 18), CD40 (Cluster of differentiation 40) ligand, MPO (Myeloperoxidase), MMP9 (Matrix metallopeptidase 9), cell-adhesion molecules, oxidized LDL (Low Density Lipoprotein), glutathione, homocysteine, fibrinogen, and D-dimer, procalcitonin. The idea of this study was to estimate usefulness of combining enzymatic markers with nonenzymatic ones in the clinical settings.

scholarly journals 2020 Russian and European clinical practice guidelines for the management of NSTEMI patients: have approaches to antithrombotic therapy been simplified?

2021 ◽  
Vol 10 (2) ◽  
pp. 92-101
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap
Keyword(s):  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Antithrombotic Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

Highlights. Prescribtion patterns of antithrombotic therapy in patients with non-ST-segment elevation acute coronary syndromes have been comapred in 2020 Russian and European clinical practice guidelines for the management of NSTEMI patients.A comparative assessment of novel approaches of antiplatelet and anticoagulant therapy recommended in 2020 European and Russian clinical practice guidelines for the management of patients with non-ST-segment elevation acute coronary syndrome is reported. In prescribing antiplatelet therapy, ESC guidelines suggest focusing attention on a more complex set of regimens to balance ischemic and hemorrhagic risks. Approaches to prescribing anticoagulant therapy do not differ in the recommendations of two medical societies. Fondaparinux has compelling advantages over other drugs regarding the combination of efficacy and safety in patients.

scholarly journals Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome

2021 ◽  
Author(s):  
Evangelos Giannitsis ◽  
Stefan Blankenberg ◽  
Robert H. Christenson ◽  
Norbert Frey ◽  
Stephan von Haehling ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Critical Appraisal ◽  
Scientific Evidence ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Scientific Support ◽  
Prognostic Assessment ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

AbstractMultiple new recommendations have been introduced in the 2020 ESC guidelines for the management of acute coronary syndromes with a focus on diagnosis, prognosis, and management of patients presenting without persistent ST-segment elevation. Most recommendations are supported by high-quality scientific evidence. The guidelines provide solutions to overcome obstacles presumed to complicate a convenient interpretation of troponin results such as age-, or sex-specific cutoffs, and to give practical advice to overcome delays of laboratory reporting. However, in some areas, scientific support is less well documented or even missing, and other areas are covered rather by expert opinion or subjective recommendations. We aim to provide a critical appraisal on several recommendations, mainly related to the diagnostic and prognostic assessment, highlighting the discrepancies between Guideline recommendations and the existing scientific evidence.

scholarly journals Diabetes mellitus and acute coronary syndromes

2021 ◽  
Vol 17 (4) ◽  
pp. 346-360
Author(s):  
V.A. Serhiyenko ◽  
A.A. Serhiyenko
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Assessment Tools ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Patients With Diabetes ◽  
Coronary Syndromes

This review article summarizes the existing literature on the current state of the problem of diabetes mellitus and acute coronary syndromes. In particular, the issues are analyzed related to the etiology, epidemiology, main pathophysiological features, classification of acute coronary syndromes, acute coronary syndromes without persistent ST-segment elevation on the electrocardiogram, acute coronary syndromes with ST-segment elevation, non-athe­rosclerotic causes of acute coronary syndrome, laboratory and instrumental diagnostic tests. Issues were analyzed related to the main approaches to the treatment of acute coronary syndromes, management of patients with diabetes mellitus and acute coronary syndromes, recommendations for secondary prevention. Initial treatment with corticosteroids includes acetylsalicylic acid, bolus heparin and intravenous heparin infusion (in the absence of contraindications). Antiplatelet therapy with ticagrelor or clopidogrel is also recommended. Pain is controlled using morphine/fentanyl and oxygen in case of hypoxia. Nitroglycerin can also be used sublingually or by infusion to relieve pain. Continuous monitoring of myocardial activity for arrhythmia is required. The choice of reperfusion strategy in patients with diabetes mellitus should be based on many factors, including assessment of clinical status (hemodynamic/electrical instability, prolonged ischemia), complications of chronic coronary syndrome, ischemic load, echocardiography, assessment of left ventricular function and any other comorbidities. In addition, various methods for assessing coronary artery disease and predicting mortality due to surgery are needed to make a final decision. Advances in the sensitivity of cardiac biomarkers and the use of risk assessment tools now enable rapid diagnosis within a few hours of symptom onset. Advances in the invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with acute coronary syndrome.

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