Acute Coronary Syndrome

First Department of Cardiology

Medical University of Gdask

Krzysztof Chlebus M.D., Ph. D., FESC

Worldwide Statistics
Each year:
> 4 million patients are admitted with
unstable angina and acute MI
> 900,000 patients undergo PTCA with or
without stent

Epidemiology
N
Euro Heart Survey 10 484

GRACE

11 543

Countries

STE-ACS

non-STE-ACS

25 Europe

42,3%

51,2%

14 World

30%

63%

Cumulative 6-month mortality

from ischemic heart disease
Deaths / 100 pts / month

25
N = 21,761; 1985-1992
Diagnosis on adm to hosp

20
15
Acute MI
Unstable angina
Stable angina

10
5
0
0

1
2
3
4
5
Months after hospital admission
Duke Cardiovascular Database

Ischemic Heart Disease

evaluation
Based on the patients
history / physical exam
electrocardiogram

Patients are categorized into 3 groups

non-cardiac chest pain
unstable angina
myocardial infarction

Classification of ACS
Traditional way:
unstabile angina
subendocardial MI
transmural MI
sudden cardiac death

Klasyfikacja ostrych zespow wiecowych

Podejcie obecne:
Rozpoznanie wstpne
Bez przetrwaego uniesienia ST
Z przetrwaym uniesieniem ST
Kocowa diagnoza:
Niestabilna choroba wiecowa
Zawa serca z uniesieniami ST
Zawa serca bez uniesienia ST
Nagy zgon sercowy

Acute Coronary Syndrome

The spectrum of clinical conditions
ranging from:
unstable angina
non-Q wave MI
Q-wave MI

characterized by the common

pathophysiology of a disrupted
atheroslerotic plaque

Acute Coronary Syndrome

(at admission)

no ST-segment elevation

ST-segment elevation

TNT+

unstabile angina

TNT+

non-Q AMI

CKMB+

Q wave AMI

Acute Coronary Syndrome

(at admission)

no ST-segment elevation

ST-segment elevation

TNT+

unstabile angina

TNT+

non STEMI

CKMB+

STEMI

Onset of STEMI
- Prehospital issues
- Initial recognition and management
in the Emergency Department (ED)
- Reperfusion

Hospital Management
- Medications
- Arrhythmias
- Complications
- Preparation for discharge
Secondary Prevention/
Long-Term Management

Management
Before STEMI

Modified from Libby. Circulation 2001;104:365,

Hamm et al. The Lancet 2001;358:1533 and
Davies. Heart 2000;83:361.

4
Presentation

Working Dx

ECG
Cardiac
Biomarker
Final Dx

Ischemic Discomfort
Acute Coronary Syndrome

No ST Elevation
UA

ST Elevation

NSTEMI

Unstable
Angina

NQMI

QwMI

Myocardial Infarction

Chronology of the
interface between the
patient and the
clinician through the
progression of plaque
formation and the
onset of complications
of STEMI.

Patomechanizm ostrych zepow

wiecowych
Odczyn zapalny jako przyczyna wystpienia OZW
Teoria niestabilnej blaszki miadycowej

Klasyczne czynniki ryzyka OZW

wysiek fizyczny
silny stres emocjonalny

The same lumen

different plaques

Circulation
Circulation 14
14 X
X 2003,
2003, 1664
1664

Acute Coronary Syndrome

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