Pearson GJ, Thanassoulis G, Anderson T, et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiol. 2021 Aug;37(8):1129-1150. doi: 10.1016/j.cjca.2021.03.016. Epub 2021 Mar 26. PMID: 33781847.
Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-1367. doi: 10.1093/eurheartj/ehaa575. Erratum in: Eur Heart J. 2021 May 14;42(19):1908. Erratum in: Eur Heart J. 2021 May 14;42(19):1925. Erratum in: Eur Heart J. 2021 May 13; PMID: 32860058.
Thygesen K, Alpert JS, Jaffe AS, et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13;138(20):e618-e651. doi: 10.1161/CIR.0000000000000617. Erratum in: Circulation. 2018 Nov 13;138(20):e652. PMID: 30571511.
Mehta SR, Bainey KR, Cantor WJ, et al; members of the Secondary Panel. 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy. Can J Cardiol. 2018 Mar;34(3):214-233. doi: 10.1016/j.cjca.2017.12.012. Epub 2017 Dec 19. PMID: 29475527.
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012 Oct;33(20):2569-619. doi: 10.1093/eurheartj/ehs215. Epub 2012 Aug 24. PMID: 22922416.
Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011 Dec 6;124(23):2574-609. doi: 10.1161/CIR.0b013e31823a5596. Epub 2011 Nov 7. Erratum in: Circulation. 2012 Feb 28;125(8):e411. PMID: 22064598.
Abraham NS, Hlatky MA, Antman EM, et al; ACCF/ACG/AHA. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010 Dec 7;56(24):2051-66. doi: 10.1016/j.jacc.2010.09.010. PMID: 21126648.
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.
An ACS with troponin elevation (myocardial infarction [MI]) is differentiated from myocardial injury by the presence of clinical markers of ischemia. Patients with MI have troponin elevations in addition to ischemic signs or symptoms, new regional wall motion abnormalities, and evidence of angiographic changes or typical findings on ECG. In contrast, patients with myocardial injury by definition have troponin elevations without these other features.
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 leads to myocardial injury manifested by elevated serum markers of myocardial necrosis without 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 myocardial necrosis manifested by increased blood levels of specific biomarkers. The most common mechanism is atherosclerotic plaque rupture with superimposed thrombosis.
We would love to hear from you
Comments, mistakes, suggestions?