Updates in Anti-anginal and Anti-ischemic Therapies for Acute Coronary Syndromes
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
Updates in Anti-anginal and Anti-ischemic Therapies for Acute Coronary Syndromes Abhizith Deoker 1 & Angelica Lehker 1 & Debabrata Mukherjee 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Acute coronary syndrome is a major health problem affecting ~ 1.5 million individuals a year in the USA. We review the contemporary role of anti-anginal and anti-ischemic therapies in the management of an individual presenting with an acute coronary syndrome. Recent Findings Early diagnosis and appropriate evidence-based therapies significantly improve clinical outcomes in acute coronary syndrome patients. Typically, acute coronary syndrome is associated with rupture of an atherosclerotic plaque and either partial or complete thrombotic occlusion of a coronary artery. Management of an acute coronary syndrome is targeted towards this underlying pathophysiology. The last few years have seen significant advances in anti-anginal and anti-ischemic therapies in the management of patients with acute coronary syndrome. Summary It is important to have a team effort to target risk reduction measures and to emphasize medication and dietary compliance. Long-term pharmacotherapy should include aspirin, beta-blocker, DAPT (for at least 1 year), statins, and ACE inhibitors and PCSK9 inhibitors if indicated. Keywords Acute coronary syndrome . Anti-anginal therapies . Anti-ischemic therapies . Anti-platelet therapies . Myocardial infarction . Outcomes
Introduction Coronary artery disease (CAD) affects 18.2 million individuals ≥ 20 years of age in the USA, with a slight male predominance based on the 2019 Heart Disease and Stroke Statistics update of the American Heart Association [1]. Among patients with CAD, acute coronary syndrome (ACS) is a major health This article is part of the Topical Collection on Management of Acute Coronary Syndromes * Debabrata Mukherjee [email protected] Abhizith Deoker [email protected] Angelica Lehker [email protected] 1
Department of Internal Medicine, Texas Tech University Health Sciences Center at El Paso, 4800 Alberta Avenue, El Paso, TX 79905, USA
problem. Approximately every 40 s, an American will have a myocardial infarction (MI) with an estimated annual incidence of 605,000 new MI and 200,000 recurrent MI attacks [1]. Patients with CAD may present either as stable angina or with an acute coronary syndrome (ACS). The spectrum of ACS includes unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). UA is characterized by the clinical presentation of angina with or without ischemic electrocardiographic (ECG) changes (ST segment depression or new T wave inversion). NSTEMI is similar to UA, but is characterized by positive cardiac biomarkers in the setting of angina and/or ECG changes. The presence of myonecrosis as evident by positive cardiac markers portends a higher risk than those pr
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