This review highlights key advances in acute coronary syndrome management, emphasizing the utility of high-sensitivity troponins, clinical risk scores like GRACE, and the efficacy of primary PCI for STEMI.
Encourages hs-troponin and GRACE integration into ACS pathways; leaves open need for prospective trials to confirm sustained mortality declines.
This overview highlights some recent advances in the epidemiology, diagnosis, risk stratification and treatment of acute coronary syndromes.The sheer volume of new studies reflects the robust state of global cardiovascular research but the focus here is on findings that are of most interest to the practising cardiologist.Incidence and mortality rates for myocardial infarction are in decline, probably owing to a combination of lifestyle changes, particularly smoking cessation, and improved pharmacological and interventional treatment.Troponins remain central for diagnosis, and new high-sensitivity assays are further lowering detection thresholds and improving outcomes.The incremental diagnostic value of other circulating biomarkers remains unclear and for risk stratification simple clinical algorithms such as the GRACE score have proved more useful.Primary PCI with minimal treatment delay is the most effective reperfusion strategy in ST elevation myocardial infarction (STEMI).Radial access is associated with
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Knight et al. (2012) studied this question.
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