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Update on the Medical Management of Acute Coronary Syndrome PowerPoint Presentation

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Published on : Mar 14, 2014
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Update on the Medical Management of Acute Coronary Syndrome

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Worldwide Statistics Each year: > 4 million patients are admitted with unstable angina and acute MI > 900,000 patients undergo PTCA with or without stent

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Myocardial Ischemia Spectrum of presentation silent ischemia exertion-induced angina unstable angina acute myocardial infarction

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Cumulative 6-month mortality from ischemic heart disease 0 1 2 3 4 5 6 5 10 0 15 20 25 Months after hospital admission Deaths / 100 pts / month Acute MIUnstable anginaStable angina Duke Cardiovascular Database N = 21,761; 1985-1992 Diagnosis on adm to hosp

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Ischemic Heart Diseaseevaluation Based on the patient’s history / physical exam electrocardiogram Patients are categorized into 3 groups non-cardiac chest pain unstable angina myocardial infarction

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Acute Coronary Syndrome Ischemic DiscomfortUnstable Symptoms No ST-segmentelevation ST-segmentelevation Unstable Non-Q Q-Waveangina AMI AMI ECG AcuteReperfusion HistoryPhysical Exam

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Acute Coronary Syndrome The spectrum of clinical conditions ranging from: unstable angina non-Q wave MI Q-wave MI characterized by the common pathophysiology of a disrupted atheroslerotic plaque

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Unstable AnginaAnti-coagulant Therapy Heparin recommendation is based on documented efficacy in many trials of moderate size meta-analyses (1,2) of six trials showed a 33% risk reduction in MI and death, but with a two fold increase in major bleeding titrate PTT to 2x the upper limits of normal 1. Circulation 1994;89:81-88 2. JAMA 1996;276:811-815

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Unstable AnginaAnti-coagulant Therapy Low-molecular-weight heparinadvantages over heparin: better bio-availability higher ratio (3:1) of anti-Xa to anti-IIa activity longer anti-Xa activity, avoid rebound induces less platelet activation ease of use (subcutaneous - qd or bid) no need for monitoring

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