Key result
Patients with acute coronary syndrome benefit from intensive medical therapy and either an early invasive or conservative treatment strategy depending on their risk for future cardiovascular events.
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This review summarizes the diagnosis and management of non-ST-segment acute coronary syndrome, highlighting the roles of intensive medical therapy and risk-stratified invasive versus conservative strategies.
OBJECTIVE: Acute coronary syndrome is a common cause of morbidity and mortality, both in the United States and worldwide. The goal of this review is to familiarize clinicians with recent information regarding the diagnosis and treatment of acute coronary syndrome. DATA SOURCES: PubMed search and review of the relevant medical literature. SUMMARY: Acute coronary syndrome encompasses three clinical diagnoses: unstable angina, non-ST-segment elevation myocardial infarction), and ST-segment elevation myocardial infarction. The definition, pathophysiology, clinical presentation, diagnosis, and treatment of unstable angina/non-ST-segment elevation myocardial infarction are reviewed here. Diagnosing unstable angina/non-ST-segment elevation myocardial infarction is a significant challenge in critically ill patients not initially suspected of having acute coronary syndrome (i.e., noncardiac intensive care unit patients), and diagnostic and treatment strategies for these patients have not been clearly established. CONCLUSIONS: Patients with acute coronary syndrome benefit from intensive medical therapy, including antianginal, antiplatelet, antithrombotic, and statin agents. Depending on their risk for future cardiovascular events as well as their risk of bleeding complications, patients may benefit from either an early invasive treatment strategy, in which routine coronary revascularization is performed, or a conservative strategy, in which revascularization is reserved for patients with recurrent or provocable cardiac ischemia.
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Trost et al. (2011) conducted a review in Acute coronary syndrome (unstable angina and non-ST-segment elevation myocardial infarction). Intensive medical therapy and early invasive or conservative treatment strategies was evaluated. Patients with acute coronary syndrome benefit from intensive medical therapy and either an early invasive or conservative treatment strategy depending on their risk for future cardiovascular events.
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