Contemporary approach to the diagnosis and management of non-ST-segment elevation acute coronary syndromes.
ABSTRACT The management of patients with acute coronary syndromes (ACS) has evolved dramatically over the past decade and, in many respects, represents a rapidly moving target for the cardiologist and internist who seek to integrate these recent advances into contemporary clinical practice. Unstable angina and non-ST-segment elevation myocardial infarction (MI) comprise a growing percentage of patients with ACS and is emerging as a major public health problem worldwide, especially in Western countries, despite significant improvements and refinements in management over the past 20 years. Against this backdrop of a multitude of randomized, controlled clinical trials that have established the scientific foundation upon which evidence-based treatment strategies have emerged and become increasingly refined, the clinician is frequently confronted with panoply of choices that can create uncertainty or confusion regarding "optimal management". While the debate about the ideal approach to the management of non-ST-segment elevation (NSTE) ACS (i.e., routine "early invasive strategy" versus an "ischemia-guided", or "conservative", strategy) has been ongoing for over a decade, clinical trials results provide compelling evidence that intermediate- and high-risk ACS patients derived significant reductions in both morbidity and mortality with mechanical or surgical intervention, especially when revascularization is coupled with aggressive, multifaceted (anti-platelet, antithrombin, anti-ischemic and anti-atherogenic) medical therapy along with risk factor modification. For these reasons, it seems especially timely and appropriate to present a state-of-the-art paper that reviews the latest advances in the management of NSTE ACS, mindful of the fact that even this noble effort to synthesize and integrate a prodigious amount of scientific information and cardiovascular therapeutics is destined to evolve still further as our full-scale assault on optimizing clinical outcomes by harmonizing the advances in mechanical and pharmacologic interventions continues unabated.
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ABSTRACT: Background & objectives: Accurate and rapid diagnosis of acute myocardial infarction (MI) is of major clinical significance. The troponin is the biomarker of choice for detection of cardiac injury. The objective of this study was to identify salivary levels of cardiac troponin I (cTnI) in patients with acute MI. Methods: Thirty patients with acute MI and 28 normal healthy individuals were included in the study. cTnI levels were assayed in serum and saliva 12 and 24 h of acute MI by ELISA method. Results: In patients with acute MI, the serum and resting (unstimulated) saliva concentrations of cTnI, but not stimulated saliva cTnI, at both 12 and 24 h of onset of MI, were significantly higher than in controls. Resting saliva cTnI concentrations correlated significantly with serum cTnI levels (spearman rho = 0.34 and 0.45 in the total individuals and in the MI patients respectively). Interpretation & conclusions: The present results suggest that saliva can be an analytical matrix for measurement of cTnI in patients with acute MI. Further studies may reveal capability of salivary cTnI for being used for developing point-of-care testing for early detection of MI in pre-clinical settings.The Indian Journal of Medical Research 12/2013; 138(6):861-5. · 1.66 Impact Factor
- The American journal of cardiology 07/2012; 110(1):145-59. DOI:10.1016/j.amjcard.2012.02.035 · 3.43 Impact Factor
Article: Cardiovascular Disease in India[Show abstract] [Hide abstract]
ABSTRACT: Cardiovascular disease (CVD) is one of the leading cause of mortality in India. It is estimated that 23.6 million CVD cases will be reported in subjects younger than 40 years of age by 2015, suggesting that young Indians are at higher cardiac risk. Evaluation of biomarkers in acute coronary syndrome (ACS) and at various stages of the disease such as inflammation, ischemia, and heart failure would indeed help to assess cardiac risk in Indian subjects. Identification of newer genetic markers through the candidate and/or genome-wide association approach would prove to be beneficial in developing a diagnostic assay for screening young asymptomatic Indian subjects.Clinics in laboratory medicine 06/2012; 32(2):217-30. DOI:10.1016/j.cll.2012.04.001 · 1.35 Impact Factor