Acute Coronary Syndromes: Diagnosis and Management, Part II

Department of Hospital Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Mayo Clinic Proceedings (Impact Factor: 5.81). 11/2009; 84(11):1021-36. DOI: 10.1016/S0025-6196(11)60674-5
Source: PubMed

ABSTRACT At the most severe end of the spectrum of acute coronary syndromes is ST-segment elevation myocardial infarction (STEMI), which usually occurs when a fibrin-rich thrombus completely occludes an epicardial coronary artery. The diagnosis of STEMI is based on clinical characteristics and persistent ST-segment elevation as demonstrated by 12-lead electrocardiography. Patients with STEMI should undergo rapid assessment for reperfusion therapy, and a reperfusion strategy should be implemented promptly after the patient's contact with the health care system. Two methods are currently available for establishing timely coronary reperfusion: primary percutaneous coronary intervention and fibrinolytic therapy. Percutaneous coronary intervention is the preferred method but is not always available. Antiplatelet agents and anticoagulants are critical adjuncts to reperfusion. This article summarizes the current evidence-based guidelines for the diagnosis and management of STEMI. This summary is followed by a brief discussion of the role of noninvasive stress testing in the assessment of patients with acute coronary syndrome and their selection for coronary revascularization.

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    ABSTRACT: It is now well-recognised that patients with auto-immune rheumatic disease (AIRD) have a predisposition to cardiovascular disease that results in increased morbidity and mortality. Following myocardial infarction (MI), patients with rheumatoid arthritis have been shown to have an increased case-fatality rate, however this has not been demonstrated in other forms of AIRD. The aim of this study was to compare case-fatality rates following a first MI in AIRD patients versus the general population. The secondary aim was to compare revascularisation treatment following MI in AIRD patients versus the general population. A retrospective cohort study using two population-based linked databases was undertaken. Cases of first MI from July 2001 to June 2007 were identified based on International Classification of Diseases (ICD-10-AM) codes. Thirty-day and one-year mortality rates were calculated (all-cause and cardiovascular causes of death). Logistic regression models were fitted to calculate the odds of mortality by AIRD status with adjustment for relevant characteristics. There were 79,390 individuals with a first MI, of whom 1,409 (1.8%) had AIRD. After adjusting for relevant covariates the odds ratio (OR) for 30-day cardiovascular mortality in AIRD patients was 1.44 (95% confidence interval (CI) 1.25 to 1.66) and for 12-month cardiovascular mortality was 1.71 (95% CI 1.51 to 1.94). The 90-day adjusted odds of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) were significantly lower in the AIRD group when compared to controls (OR 0.81, 95% CI: 0.70 to 0.94 and OR 0.52, 95% CI: 0.39 to 0.69, respectively). We identified a higher risk-adjusted mortality rate for the majority of AIRD patients at 30-days and 12 months after first MI. We also identified lower post-MI revascularisation rates in the AIRD group, suggesting there may be current gaps in cardiovascular treatment for AIRD patients.
    Arthritis research & therapy 12/2015; 17(1):552. DOI:10.1186/s13075-015-0552-2 · 4.12 Impact Factor
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    Arthritis Research & Therapy 09/2014; 16(5):443. DOI:10.1186/s13075-014-0443-y · 4.12 Impact Factor
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    09/2014; 13(3):184-9. DOI:10.4103/1450-1147.144819


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