Key steps in the hospital management strategy of patients with NSTE-ACS are optimal antithrombotic therapy and coronary angiography often with subsequent revascularization by PCI or CABG. Some patients need particular attention:
Women may present late and are often older with more comorbidity. Spontaneous coronary artery dissection and Tako-Tsubo cardiomyopathy are more frequent in women.
Diabetes is associated with more diffuse coronary artery disease. If 3-VD is present CABG should be considered.
CKD patients might need dose reduction of some antithrombotics and can frequently be treated with well-planned PCI – take care of the contrast load.
Elderly patients should usually undergo coronary angiography and be treated with antithrombotics. PCI is often the preferred revascularization strategy.
Prof. Steen Kristensen, MD, DMSc, FESC
Department of Cardiology,
Aarhus University Hospital, Denmark
Resources below have been selected by Dr. Edina Cenko
Non-ST-elevation Acute Coronary Syndromes - Chapter 47
Acute Cardiovascular Care Congress Resources
A selection of resources from Acute Cardiovascular Care 2019:
- Early risk stratification of a patient with chest pain: emerging paradigms
- Long term treatment: the importance of getting it right the first time!
Clinical Decision-Making Toolkit
- Key symptoms: Chest pain
- Acute coronary syndromes: General concepts & non ST-segment elevation ACS
- Thromboprophylaxis in acutely ill medical patients and in those with acute cardiovascular disease or undergoing cardiovascular procedures
European Heart Journal - Acute Cardiovascular Care
Access a selection of relevant scientific papers in the field:
- Sex-related differences in baseline characteristics, management and outcome in patients with acute coronary syndrome without ST-segment elevation
- Revascularisation in older adult patients with non-ST-segment elevation acute coronary syndrome: effect and impact on 6-month mortality
- Excess mortality and guideline-indicated care following non-ST-elevation myocardial infarction
- Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men
- Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial
- Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association
- Acute versus subacute angiography in patients with non-ST-elevation myocardial infarction – the NONSTEMI trial phase I.
- Acute coronary syndromes in insulin treated diabetics, elderly and female patients: remaining gaps in EMS activation, therapy and clinical outcomes
- Outcomes of medically managed patients with myocardial infarction
- Frailty and acute coronary syndrome: A structured literature review
- Outcomes after planned invasive or conservative treatment strategy in patients with non-ST-elevation acute coronary syndrome and a normal value of high sensitivity troponin at randomisation: A Platelet Inhibition and Patient Outcomes (PLATO) trial biomarker substudy
- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction – data from the SWEDEHEART registry
ESC Clinical Practice Guidelines
A selection of relevant ESC Guidelines in the field
- 2018 ESC/EACTS Guidelines on myocardial revascularization.
- Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction
- ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (Section 7. Management of stable and unstable coronary artery disease in patients with diabetes)
- ESC Guidelines for the management of cardiovascular diseases during pregnancy. (Section 7. Coronary artery disease)
- ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)