Acute coronary syndrome

Acute coronary syndrome
Blockage of a coronary artery
Specialty	Cardiology

Acute coronary syndrome (ACS) is a

Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use.^[11] Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia, brady- or tachycardia (excessively slow or rapid heart rate), low or high blood pressure, severe aortic valve stenosis (narrowing of the valve at the beginning of the aorta), pulmonary artery hypertension and a number of other conditions.^[12]

Pathophysiology

In those who have ACS,

Other, less common, causes of acute coronary syndrome include spontaneous coronary artery dissection,[14] ischemia in the absence of obstructive coronary artery disease (INOCA), and myocardial infarction in the absence of obstructive coronary artery disease (MINOCA).^[15]

Diagnosis

Electrocardiogram

In the setting of acute chest pain, the

A combination of cardiac biomarkers and risk scores, such as HEART score and TIMI score, can help assess the possibility of myocardial infarction in the emergency setting.^[19][13]

Prevention

Acute coronary syndrome often reflects a degree of damage to the coronaries by

After a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17% reduction in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers.[21]

Treatment

People with presumed ACS are typically treated with aspirin,

The TIMI risk score can identify high risk patients in ST-elevation and non-ST segment elevation MI ACS^[30][31] and has been independently validated.^[32][33]

Based on a global registry of 102,341 patients, the GRACE risk scoreestimates in-hospital, 6 months, 1 year, and 3-year mortality risk after a heart attack.^[34] It takes into account clinical (blood pressure, heart rate, EKG findings) and medical history.^[34] Nowadays, GRACE risk score is also used within non-ST elevation ACS patients as a high-risk criteria(GRACE score > 140), which may favor early invasive strategy within 24 hours of the heart attack.^[35]

Biomarkers

The aim of prognostic markers is to reflect different components of pathophysiology of ACS. For example:^{[citation needed]}

• Natriuretic peptide – both B-type natriuretic peptide (BNP) and N-terminal proBNP can be applied to predict the risk of death and heart failure following ACS.
• Monocyte chemo attractive protein (MCP)-1 – has been shown in a number of studies to identify patients with a higher risk of adverse outcomes after ACS.

Coronary CT angiography combined with troponin levels is also helpful to triage those who are susceptible to ACS. F-fluoride positron emission tomography is also helpful in identifying those with high risk, lipid-rich coronary plaques.^[13]

Day of admission

Studies have shown that for ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to the possible conclusion that access to diagnostic/interventional procedures may be contingent upon the day of admission, which may impact mortality.^[36][37] This phenomenon is described as weekend effect.

See also

• Allergic acute coronary syndrome
  (Kounis syndrome)

References