Ischaemic Heart Disease

Acute Coronary Syndrome

Desired Outcomes
• Prevent acute coronary syndrome and death
• Alleviate acute symptoms of myocardial ischemia
• Prevent recurrent symptoms of myocardial ischemia
• Prevent progression of the disease
• Reduce complications of IHD
• Avoid or minimize adverse treatment effects
Acute Coronary Syndrome
ACS Spectrum
• From acute myocardial ischemia
to MI resulting from an
imbalance between myocardial
ACS
oxygen demand and supply

• results primarily from

STEMI NSTE-ACS
diminished myocardial blood
flow secondary to an occlusive
or partially occlusive coronary
NSTEMI
UA
artery thrombus Troponin
Risk Stratification
• GRACE
• http://www.outcomes-umassmed.org/GRACE/acs_risk/acs_risk_content.html
• TIMI
• https://www.mdcalc.com/timi-risk-score-ua-nstemi
• ACS NSQIP
• https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp
• ACC/AHA
• http://www.cvriskcalculator.com/
Desired Outcomes
• Short-term: • Long-term:
• early restoration of blood flow to the • control of CV risk factors,
infarct-related artery to prevent • prevention of additional CV events,
infarct expansion (in the case of MI) including reinfarction, stroke, and HF,
or prevent complete occlusion and MI and
(in UA); • improvement in quality of life
• prevention of death and other MI
complications;
• prevention of coronary artery
reocclusion;
• relief of ischemic chest discomfort;
and
• resolution of ST segment and T-wave
changes on the ECG
Terima kasih