scholarly journals Choice of revascularization method in acute coronary syndrome with non-ST-segment elevation

2021 ◽  
Vol 10 (2) ◽  
pp. 58-62
Author(s):  
A. B. Nishonov ◽  
R. S. Tarasov
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes

Aim. To analyze the results of various revascularization techniques in high-risk non – STsegment elevation in acute coronary syndromes performed during the first 24 hours.Methods. As a part of a single-center retrospective study, 45 cases of coronary artery bypass grafting (CABG) were examined in high-risk non – ST-segment elevation in acute coronary syndromes patients during the first 24 hours since their hospitalization for the period from 2017 to 2020. 45 cases of percutaneous coronary intervention (PCI) were selected from a similar group of patients with the help of the copy-pair method.Results. The groups were comparable according to such significant factors as age, gender, postinfarction cardiosclerosis, diabetes mellitus, and multifocal atherosclerosis. However, the severity of coronary atherosclerosis according to the Syntax score was significantly higher in the CABG group (p = 0.0004). The groups were comparable in achieving complete revascularization (p = 0.2). In 8.9% (n = 4) of patients in the PCI group, unscheduled repeated revascularization was required, and in 15.6% (n = 7) of cases stent restenosis/thrombosis was detected during the hospital period and between PCI stages, while in the CABG group, congenital malformations and dysfunction were not found. Mortality in the groups did not differ significantly (4 (8.8%) versus 2 (4.4%), p = 0.4).Conclusion. CABG provides freedom from repeated revascularizations, despite the initially more severe coronary lesion. 

Percutaneous coronary interventions in acute coronary syndromes

2016 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Criterion ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk

Diagnosis and management of non-STEMI coronary syndromes

2016 ◽  
Author(s):  
David Erlinge ◽  
Göran Olivecrona
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Artery Bypass ◽  
Adenosine Diphosphate ◽  
Coronary Intervention ◽  
Stemi Patient ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes

Acute coronary syndromes are classified as ST segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or unstable angina. Most patients with NSTEMI present with a history of chest pain that has subsided spontaneously before or soon after arrival at the emergency room, but with positive cardiac markers (usually troponin T or I) indicative of myocardial infarction. NSTEMI has a risk of recurrent myocardial infarction of 15–20% and a 15% chance of 1-year mortality. Patients with non-STE-acute coronary syndromes are at similar risk as a STEMI patient at 1 year. The strongest objective signs of NSTEMI are a positive troponin and ST segment depression. NSTEMI should be acutely treated with aspirin, an adenosine diphosphate-receptor antagonist, and an anticoagulant (fondaparinux or low molecular weight heparins). NSTEMI should be investigated with coronary angiography within 72 hours. Curative treatment is percutaneous coronary intervention or coronary artery bypass grafting.

Percutaneous coronary interventions in acute coronary syndromes

2017 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Risk Groups ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.

Percutaneous coronary interventions in acute coronary syndromes

2015 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Criterion ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk

Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes

2018 ◽  
Author(s):  
Peter Sinnaeve ◽  
Frans Van de Werf
Keyword(s):  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Long Term Treatment ◽  
Coronary Syndromes

Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.

Percutaneous coronary interventions in acute coronary syndromes

2018 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Risk Groups ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.

Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes

2015 ◽  
Author(s):  
Peter Sinnaeve ◽  
Frans Van de Werf
Keyword(s):  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Long Term Treatment ◽  
Coronary Syndromes

Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.

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