Acute Coronary Syndrome

2015 ◽  
pp. 136-167
Author(s):  
Brandon W. Calenda ◽  
Umesh K. Gidwani
Keyword(s):  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Treatment Options ◽  
Coronary Intervention ◽  
Preventative Care ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Lethal Event ◽  
New Generation ◽  
Intraaortic Balloon Counterpulsation

Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of an atherosclerotic plaque. Patients presenting with ACS can be rapidly risk stratified based on signs, symptoms, electrocardiogram, and biomarkers. There is a new generation of potent and reliable antiplatelet drugs, which in concert with anticoagulation and rapid revascularization, can preserve myocardium and save lives. When choosing how to revascularize, hemodynamically stable patients with diabetes mellitus and complex coronary disease benefit more from coronary artery bypass grafting rather than percutaneous coronary intervention. Despite optimal treatment, ACS can result in deadly complications such as cardiogenic shock. Supportive care is paramount, but despite its widespread use, the utility of intraaortic balloon counterpulsation is uncertain. In the future, advanced coronary imaging may enhance preventative care, novel molecular targets will help expand treatment options, and cell-based regenerative therapies may aid myocardial recovery after acute coronary syndrome.

Acute Coronary Syndrome

2017 ◽  
pp. 194-225
Author(s):  
Brandon W. Calenda ◽  
Umesh K. Gidwani
Keyword(s):  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Treatment Options ◽  
Coronary Intervention ◽  
Preventative Care ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Lethal Event ◽  
New Generation ◽  
Intraaortic Balloon Counterpulsation

Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of an atherosclerotic plaque. Patients presenting with ACS can be rapidly risk stratified based on signs, symptoms, electrocardiogram, and biomarkers. There is a new generation of potent and reliable antiplatelet drugs, which in concert with anticoagulation and rapid revascularization, can preserve myocardium and save lives. When choosing how to revascularize, hemodynamically stable patients with diabetes mellitus and complex coronary disease benefit more from coronary artery bypass grafting rather than percutaneous coronary intervention. Despite optimal treatment, ACS can result in deadly complications such as cardiogenic shock. Supportive care is paramount, but despite its widespread use, the utility of intraaortic balloon counterpulsation is uncertain. In the future, advanced coronary imaging may enhance preventative care, novel molecular targets will help expand treatment options, and cell-based regenerative therapies may aid myocardial recovery after acute coronary syndrome.

Coronary artery bypass graft surgery

2017 ◽  
Author(s):  
Piroze M Davierwala ◽  
Friedrich W Mohr
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

scholarly journals Complex Percutaneous Coronary Intervention Salvages a Patient with Recurrent Acute Coronary Syndrome and Ischaemic Heart Failure with Multiple Life Threatening Co-morbidities: A Case Report

2021 ◽  
Author(s):  
Brajesh Kunwar ◽  
Farah Ingle ◽  
Atul Ingle ◽  
Chandrasekhar Tulagseri
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Coronary Intervention ◽  
Middle Income ◽  
Coronary Syndrome ◽  
Artery Disease

More than 422 million people are suffering from Diabetes Mellitus (DM) worldwide. Majority of the affected population resides in lower and middle income countries. This chronic, metabolic disease gradually does serious damage to heart, blood vessels, eyes, kidneys and nerves; eventually causing cardiovascular diseases, peripheral vascular diseases, retinopathy, nephropathy and neuropathy. Here, a rare case of a 58-year-old male was present who had history of uncontrolled DM with dry gangrene in right forefoot, acute kidney injury and Coronary Artery Disease (CAD) involving Left Main (LM) bifurcation presented with recurrent acute coronary syndrome with heart failure. Patient in view of multiple co-morbidities was unfit for Coronary Artery Bypass Grafting (CABG) was managed successfully with complex coronary intervention involving LM bifurcation.

scholarly journals Adherence to Medical Treatment in Patients who Have Experienced Acute Coronary Syndrome and Percutaneous Coronary Intervention

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 36-38
Author(s):  
N. M. Kuzmina ◽  
N. I. Maximov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
Adherence To Therapy

Purpose: to study adherence to therapy after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We analyzed retrospectively 127 case histories of patients who underwent PCI for ACS in 2015 (in Udmurtia at that time PCIs were mostly carried out later than 6 hours after onset of symptoms). Inclusion criteria: age 25–75 years; confirmed ACS; stenting of coronary arteries for the first time. Exclusion criteria: pregnancy; prisoners; incompetent persons; history of PCI or coronary artery bypass grafting. In two years after the PCI 95 patients were questioned concerning use of statins (including their doses) and dual antiplatelet therapy (DAPT). Results. In 2 years after index PCI 83% of patients took statins regularly. DAPT for 1 year or more after PCI received 85% of patients. Conclusion. Adherence to therapy with statins and antiplatelet therapy was found to be high. PCI in patients with ACS was mainly delayed (more than 6 hours from the onset of symptoms). It is necessary to further improve the routing of patients to PCI performing centers from Udmurtia regions for the timely myocardial revascularization.

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Heart ◽  
2019 ◽  
pp. heartjnl-2019-315655 ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Corina Grey ◽  
Yannan Jiang ◽  
Rodney T Jackson ◽  
Andrew J Kerr
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Procedure ◽  
St Elevation ◽  
Event Rates ◽  
Invasive Management

ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

Coronary artery bypass graft surgery

2021 ◽  
pp. 565-584
Author(s):  
Piroze M Davierwala ◽  
Michael A Borger
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Cardiac Surgeon

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

Sign in / Sign up

Export Citation Format

Share Document