ACUTE CORONARY ACUTE CORONARY SYNDORME SYNDORME

Mostafa alshamiriJanuary 2013

Definitions – Definitions – Acute coronary Acute coronary syndromesyndrome

Any constellation of clinical symptoms that are compatible with acute myocardial ischemia.

It encompasses a spectrum fromAMI to UA

A- myoglobin/CK-MB isoforms after AMIB – Cardiac Troponin after AMIC - CK-MB after AMID – Cardiac Troponin after UA

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Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS)

Acute Coronary Syndromes*

1.57 Million Hospital Admissions - ACS

UA/NSTEMI† STEMI

1.24 million Admissions per

year

0.33 million Admissions per

year

Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115:69-171. *Primary and secondary diagnoses. †About 0.57 million

NSTEMI and 0.67 million UA.

Killip classification CardiologyKillip classification CardiologyA system used to stratify the severity of left

ventricular dysfunction and determine clinical status of Pts post MI :

Class 1 No rales, no 3rd heart sound Class 2 Rales in <1⁄2 lung field or presence of a 3rd

heart sound Class 3 Rales in >1⁄2 lung field–pulmonary edema

Class 4 Cardiogenic shock–determined clinically

STEMI

NSTEMINSTEMI

Treatment of ACSTreatment of ACSASAClopedogrilHeparineReperfusion lytic or PPCI for STEMIGlycoprotein IIB-IIIA receptor antagonist

(NSTEMI)Statins BBACEI or ARBsSymptomatic treatment MONA

SummarySummary

High risk patients – 1.7% risk of death after 30 days

Intermediate patients – 1.2% risk of death after 30 days

Low risk patients – no death after 30 days