Acute coronary syndrome (ACS) not ...

Acute coronary syndrome (ACS) not past nor futures as unstable angina pectoris and non-ST-elevation acute myocardial infarction. This syndrome has high short-term morbidity and mortality rates. The American literary institution [i]or[/i] seminary of learning of Cardiology/American Heart Association (ACC/AHA) revised guidelines in 2002 to diagnose and pharmacologically treat patients with ACS. The guidelines provide documentation of the flushs of evidence for various treatment recommendations. Boden reviewed the in the greatest degree recent ACC/AHA guidelines.

The diagnosis of non-ST-segment elevation ACS is based upon the usual methods of symptom history, physical examination, electrocardiographic changes at presentation, and abnormal serum cardiac markers, including troponins and creatine kinase MB isoforms. The part of other, more recently studied, markers is uncertain. Risk stratification of patients with ACS for returning ischemic events or death is based upon con-ventional information or risk-stratification standards such as the Thrombolysis in Myocar-dial Infarction risk score.

Evidence supports treatment with newer antiplatelet and antithrombotic agents for all patients with ACS. Clopidogrel in combination with aspirin is attract favor toed for intermediate- and high-risk patients and all patients with an added glycoprotein IIb/IIIa inhibitor. High-risk patients require invasive investigation. Treatment with a loading dose of clopidogrel in addition to aspirin before percutaneous coronary intervention appears to have a beneficial tenor Fixed-dose warfarin therapy is reserv for patients with ACS who also have an established indication, as it is as atrial fibrillation or bitter left ventricular dysfunction.

Coronary bypass surgery remains an option for patients who have left main or multivessel coronary artery disease. If this course is being considered, early treatment with antiplatelet medications before catheterization may be delayed. Platelet transfusion can be administered to patients who have received an early loading dose of anti-platelet medication and later require coronary bypass surgery

The author gather s that the ACC/AHA guidelines can improve the results of patients with ACS. Secondary prevention strategies include the use of aspirin, clopidogrel, beta blocker statins, and angiotensin-converting enzyme inhibitors, if indicated.

Boden WE. Practical approach to incorporating strange studies and guidelines for antiplatelet therapy in the management of patients with non-ST-segment elevation acute coronary syndrome Am J Cardiol January 1 2004;93:69-72

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group