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Acute coronary syndrome (ACS) is a clinical syndrome of acute chest pain related to acute myocardial ischemia. ACS is classified based on electrocardiography (ECG) results into ST-segment elevation ACS and non–ST-segment elevation ACS. This approach has important practical implications because patients presenting with ST-segment elevation ACS require immediate reperfusion therapy.
Definition Top
Classification of ACS: see Ischemic Heart Disease.
Definition of myocardial infarction: see Table 3.11-1.
1. Non–ST-segment elevation ACSs (unstable angina [UA]/non–ST-segment elevation myocardial infarction [NSTEMI]) are caused by acute myocardial ischemia that in some patients leads to myocardial necrosis manifested by elevated serum markers of myocardial necrosis without an acute ST-segment elevation seen on ECG. Patients with UA/NSTEMI constitute a heterogeneous group due to the complex pathogenesis, which includes atherosclerotic plaque rupture with superimposed thrombosis, progressive obstruction of a coronary artery, arterial constriction, inadequate oxygen supply relative to myocardial demand, or spontaneous coronary dissection.
2. ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome usually caused by the cessation of blood flow through a coronary artery due to its occlusion, which results in transmural ischemia leading to ST-segment elevation and typically myocardial necrosis manifested by increased blood levels of specific biomarkers.
McMaster Textbook of Internal Medicine acknowledges the important contribution of Cochrane Canada and its authors in development of the textbook.