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2023 ESC Guidelines, ACS - Copy.pptx
- 1. 2023 ESC Guidelines_---- ACS Dr Rajesh Ponnada Cardiology Resident Apollo Hospital, Visakhapatnam
- 2. Introduction Triage and diagnosis Diagnostic tools | Biomarkers Suspected ACS Acute-phase management of patients Antithrombotic therapy ACS with unstable presentation Management of ACS during hospitalization Technical aspects of invasive strategies Management of patients with multivessel disease Myocardial infarction with non-obstructive coronary arteries Special situations
- 3. First medical contact (FMC) The time point when the patient is initially assessed STEMI diagnosis The time at which a patient with ischaemic symptoms is interpreted as STEMI Primary PCI Emergent PCI with balloon, stent, or other approved device, Primary PCI strategy Emergency coronary angiography and PCI of the IRA if indicated Rescue PCI Emergency PCI performed as soon as possible in cases of failed fibrinolytic treatment Routine early PCI strategy after fibrinolysis Coronary angiography, with PCI of the IRA if indicated, performed between 2 h and 24 h after successful fibrinolysis Pharmaco-invasive strategy Fibrinolysis combined with rescue PCI, or routine early PCI strategy (in cases of successful fibrinolysis) Immediate invasive strategy Emergency coronary angiography (i.e. as soon as possible) Early invasive strategy Early coronary angiography (<24 h from diagnosis of ACS) and Selective invasive strategy Coronary angiography ± PCI/CABG based on clinical assessment and/or non-invasive testing
- 6. ACS is not the same as MI AMI Myocardial injury AMI is defined as cardiomyocyte necrosis in the clinical setting of acute myocardial ischaemia Troponin release due to mechanisms other than myocardial ischaemia Acute or chronic (dynamic change in the elevated troponins on serial testing. myocarditis, sepsis, takotsubo cardiomyopathy, heart valve disease, cardiac arrhythmias, and heart failure (HF)
- 19. Thank you…..
Editor's Notes
- If ACS is suspected, think ‘A.C.S.’ for the initial triage and assessment. This involves performing an electrocardiogram (ECG) to assess for Abnormalities or evidence of ischaemia, taking a targeted clinical history to assess the clinical Context of the presentation, and carrying out a targeted clinical examination to assess for clinical and haemodynamic Stability. Based on the initial assessment, the healthcare provider can decide whether immediate invasive management is required. Patients with ST-elevation myocardial infarction (STEMI) require primary percutaneous coronary intervention (PPCI) (or fibrinolysis if PPCI within 120 min is not feasible); patients with non-ST-elevation ACS (NSTE-ACS) with very high-risk features require immediate angiography ± PCI if indicated; patients with NSTE-ACS and high-risk features should undergo inpatient angiography (angiography within 24 h should be considered). A combination of antiplatelet and anticoagulant therapy is indicated acutely for patients with ACS. The majority of patients with ACS will eventually undergo revascularization, most commonly with PCI. Once the final diagnosis of ACS has been established, it is important to implement measures to prevent recurrent events and to optimize cardiovascular risk. This consists of medical therapy, lifestyle changes and cardiac rehabilitation, as well as consideration of psychosocial factors.
- Acute coronary syndromes (ACS) encompass a spectrum of conditions that include patients presenting with recent changes in clinical symptoms or signs, with or without changes on 12-lead electrocardiogram (ECG) and with or without acute elevations in cardiac troponin (cTn) concentrations Patients presenting with suspected ACS may eventually receive a diagnosis of acute myocardial infarction (AMI) or unstable angina (UA). The diagnosis of myocardial infarction (MI) is associated with cTn release and is made based on the fourth universal definition of MI. UA is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. It is characterized by specific clinical findings of prolonged (>20 min) angina at rest; new onset of severe angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of MI. However, after the acute management and stabilization phase, most aspects of the subsequent management strategy are common to all patients with ACS (regardless of the initial ECG pattern or the presence/absence of cardiac troponin elevation at presentation) and can therefore be considered under a common pathway
- The focus of this guideline is largely centred on the management of patients who will eventually receive a diagnosis of Type 1 MI, physicians must carefully consider other differential diagnoses in their clinical assessment because they are common, associated with different underlying pathological mechanisms