Acute coronary syndromes

2018 ◽  
Author(s):  
Cheerag Shirodaria ◽  
Sam Dawkins
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Myocardial Necrosis ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Depression ◽  
Wave Inversion ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Difference

The term ‘acute coronary syndrome’ includes unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). The difference between these three syndromes is as follows. In STEMI and NSTEMI, there is evidence of myocardial necrosis, as evidenced by raised cardiac enzymes, specifically, the very sensitive cardiac biomarker troponin. STEMI is diagnosed when the ECG shows persisting ST elevation in an appropriate territory consistent with STEMI whereas, in NSTEMI, there can be any or no ECG changes, or very transient, self-limiting ST elevation. In unstable angina, there is no myocardial necrosis, and troponins are normal. The ECG is as for NSTEMI and often shows no change, ST depression, or T-wave inversion. The prognoses in STEMI and NSTEMI are identical; unstable angina has a better prognosis than either STEMI or NSTEMI.

P1695Incidence and outcomes of unstable angina compared to non-ST elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Puelacher ◽  
M Gugala ◽  
P D Adamson ◽  
A S V Shah ◽  
A R Chapmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
St Elevation ◽  
Heart Foundation

Abstract Objective Assess the incidence and compare characteristics and outcome of unstable angina (UA) and Non-ST-Elevation myocardial infarction (NSTEMI) Design Two independent prospective multicenter diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome (High-STEACS)) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30-days and 1-year. Results 8992 patients were enrolled at 11 centres. UA was adjudicated in 366/4122 (8.9%) and 137/4870 (2.8%) patients in APACE and High-STEACS, respectively, and NSTEMI in 622 (15.1%) and 651 (13.4%). Coronary artery disease was pre-existing in 73% and 76% of patients with unstable angina. At 30-days, all-cause mortality in UA was substantially lower as compared to NSTEMI (0.5% versus 3.7%, p=0.002 in APACE, 0.7% versus 7.4%, p=0.004 in High-STEACS). Similarly, at 1-year in UA all-cause mortality was 3.3% [95% CI 1.2–5.3] vs 10.4% [7.9–12.9] in APACE, and 5.1% [0.7–9.5] vs 22.9% [19.3–26.4] in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, [7.8–14.6] and 7.9%, [5.7–10.2]), and higher than in NCCP (0.6%, [0.2–1.0]). 1-year survival free from future AMI Conclusions The incidence and the mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar. Acknowledgement/Funding Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, British Heart Foundation Project Grants, Butler S

scholarly journals Current Knowledge of MicroRNAs (miRNAs) in Acute Coronary Syndrome (ACS): ST-Elevation Myocardial Infarction (STEMI)

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1057
Author(s):  
Daniela Maria Tanase ◽  
Evelina Maria Gosav ◽  
Anca Ouatu ◽  
Minerva Codruta Badescu ◽  
Nicoleta Dima ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Development ◽  
Current Knowledge ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Damage ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease ◽  
Potential Use

Regardless of the newly diagnostic and therapeutic advances, coronary artery disease (CAD) and more explicitly, ST-elevation myocardial infarction (STEMI), remains one of the leading causes of morbidity and mortality worldwide. Thus, early and prompt diagnosis of cardiac dysfunction is pivotal in STEMI patients for a better prognosis and outcome. In recent years, microRNAs (miRNAs) gained attention as potential biomarkers in myocardial infarction (MI) and acute coronary syndromes (ACS), as they have key roles in heart development, various cardiac processes, and act as indicators of cardiac damage. In this review, we describe the current available knowledge about cardiac miRNAs and their functions, and focus mainly on their potential use as novel circulating diagnostic and prognostic biomarkers in STEMI.

Abstract 17143: Acute Coronary Syndromes Associated With SARS-CoV-2 Infection Admissions in a Medium Size Community Hospital

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ANDREEA-CONSTANTA STAN ◽  
Momcilo Durdevic ◽  
Rosario Florante ◽  
Arshavir Artashesyan ◽  
Henrik Elenius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Chest Pain ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Type Ii ◽  
Primary Care Teams ◽  
Coronary Syndromes ◽  
St Elevation

Background: The presence of cardiovascular complications were reported in small studies of critical care patients admitted with SARS-CoV-2infection There is a dearth of data regarding presence of acute coronary syndromes (ACS) in patients admitted with symptomatic SARS-CoV-2 infection, the cause of the myocardial injury and particularities of management. Objectives: The aim of the study is to describe the presence and type ACS in patients admitted with symptomatic SARS-CoV-2 infection. Secondary outcomes were contributing factors, presenting symptoms and medical management. Methods: A descriptive, retrospective study of patients with a positive COVID-19 test and symptomatic infection admitted from 10 March 2020 to 10 April 2020 in our hospital. Results: There were a total of 127 patients admitted with symptomatic SARS-CoV-2 infection. The most common ACS was Type II Myocardial Infarction (MI). 16 patients were diagnosed with type II MI, 3 patients with Non ST elevation myocardial infarction (NSTEMI) and no patient was diagnosed with unstable angina and ST elevation myocardial infarction (STEMI). The most common cause of Type II MI was hypoxia followed by congestive heart failure and new onset atrial fibrillation. One patient has chest pain as presenting symptom. Except for Aspirin loading and use of beta blocker no other antischemic, statin or ACE/ARB medication was used for management of type II MI. All patients with Type II MI were managed by primary care teams. 3 patients developed NSTEMI and were managed by primary care teams with Cardiology consults. Anti-coagulation was considered for all patients. All patients received Aspirin loading, high intensity statin and beta blockers. Conclusions: Majority of patients with ACS had symptoms related to SARS-CoV-2 infection and chest pain was absent in 95% of cases. The most common ACS was type II MI- myocardial ischemia in context of hypoxia and the treatment was focused in treating the underlying cause rather than initiation of classical guideline directed therapy or invasive management. There were no cases of unstable angina and STEMI, results consistent with previous studies underlying the low incidence of STEMI cases during this pandemic.

Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction

Heart ◽  
2019 ◽  
Vol 105 (18) ◽  
pp. 1423-1431 ◽  
Author(s):  
Christian Puelacher ◽  
Mathias Gugala ◽  
Philip D Adamson ◽  
Anoop Shah ◽  
Andrew R Chapman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Relative Incidence ◽  
Incidence And Mortality ◽  
All Cause Mortality ◽  
St Elevation

ObjectiveAssess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI).DesignTwo independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year.Results8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0).ConclusionsThe relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.

scholarly journals Assessment of Thrombolysis in Myocardial Infarction Risk Score in Acute Coronary Syndrome among Saudi and non-Saudi Patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

2018 ◽  
Vol 8 (1) ◽  
pp. 25-32
Author(s):  
Wesam A. Alhejily ◽  
Raneem Ahmed Fallatah ◽  
Haneen Hussain Alabsi ◽  
Hadeel Sameer Ashi ◽  
Shahad Majed Alharbi
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Risk Score ◽  
St Elevation Myocardial Infarction ◽  
University Hospital ◽  
Coronary Syndrome ◽  
King Abdulaziz University ◽  
St Elevation ◽  
Saudi Patients

Background: One third of all deaths worldwide are attributed to acute coronary syndrome. The thrombolysis in Myocardial Infarction Risk Score is used to assess the risk of mortality and major adverse outcomes in this population. This study aimed to assess and compare the morbidity and mortality differences rate between Saudi and non-Saudi patients with acute coronary syndrome. Methods: This retrospective study was conducted at the coronary care unit of King Abdulaziz University Hospital. All acute coronary syndrome cases were enrolled and assessed using the thrombolysis in Myocardial Infarction Risk Score. Results: 242 cases were divided as 98 ST-elevation myocardial infarction cases and 144 unstable angina/non ST-elevation myocardial infarction. Among ST-elevation myocardial infarction patients 21 were Saudi patients and 77 were non-Saudi patients with the median thrombolysis in myocardial infarction risk score for Saudi was 5 and for non-Saudi 3.5 (P = 0.6). Unstable angina/non ST-elevation myocardial infarction cases had 47 Saudi patients and 94 non-Saudi patients with the median score was 4.2 for Saudis versus 4.5 for non-Saudis (P = 0.4). Conclusion: Overall thrombolysis in myocardial infarction were higher in Saudis with ST-elevation myocardial infarction than non-Saudis, and higher for non-Saudis with unstable angina/non ST-elevation myocardial infarction than Saudis. However, the difference was not significant (p = 0.6, p = 0.4). The 30 days and one-year mortality as well as major adverse cardiac events were similar between the two groups in ST-elevation myocardial infarction (P = 0.4 and 0.7) and unstable angina/non ST-elevation myocardial infarction population (P = 0.3 and 0.3).

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