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  • Image not available. The cause of an acute coronary syndrome (ACS) is the rupture of an atherosclerotic plaque with subsequent platelet adherence, activation, and aggregation, and the activation of the clotting cascade. Ultimately, a clot forms composed of fibrin and platelets.
  • Image not available. The American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and Society for Cardiovascular Angiography and Interventions (SCAI) recommend strategies, or guidelines, for ACS patient care for ST-segment elevation (STE) myocardial infarction (MI) and non–ST-segment elevation (NSTE) ACS, including guidelines for patients undergoing percutaneous coronary intervention (PCI).
  • Image not available. Patients with ischemic chest discomfort and suspected ACS are risk-stratified based on a 12-lead electrocardiogram (ECG), past medical history, and results of the troponin and creatine kinase (CK)–myocardial band (MB) tests. The diagnosis of MI is confirmed based on the results of the CK-MB and troponin biochemical marker tests.
  • Image not available. Early reperfusion therapy with primary PCI of the infarct artery is the recommended therapy for patients presenting with STE MI within 12 hours of symptom onset.
  • Image not available. The most recent PCI ACCF/AHA/SCAI clinical practice guidelines recommend coronary angiography with either PCI or coronary artery bypass graft (CABG) surgery revascularization as an early treatment (early invasive strategy) for patients with NSTE ACS at an elevated risk for death or MI, including those with a high risk score or patients with refractory angina, acute heart failure, other symptoms of cardiogenic shock, or arrhythmias.
  • Image not available. In addition to reperfusion therapy, other early pharmacotherapy that all patients with STE MI and without contraindications should receive within the first day of hospitalization, and preferably in the emergency department, are intranasal oxygen (if oxygen saturation is low), sublingual (SL) nitroglycerin (NTG), aspirin (ASA), a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor depending on reperfusion strategy), and anticoagulation with bivalirudin, unfractionated heparin (UFH), enoxaparin, (agent dependent on reperfusion strategy), or fondaparinux. A glycoprotein (GP) IIb/IIIa inhibitor should be administered if UFH is selected as the anticoagulant for patients undergoing primary PCI. A statin should be administered prior to PCI. IV β-blockers and IV NTG should be given in selected patients. Oral β-blockers should be initiated within the first day in patients without contraindications.
  • Image not available. In the absence of contraindications, all patients with NSTE ACS should be treated in the emergency department with intranasal oxygen (if oxygen saturation is low), SL NTG, ASA, and an anticoagulant (UFH, enoxaparin, fondaparinux, or bivalirudin). High-risk patients should proceed to early angiography, and may receive a GP IIb/IIIa inhibitor. A P2Y12 inhibitor (selection of agent and timing of initiation dependent on selection of an interventional approach involving PCI or CABG surgery vs. a noninterventional approach with medical management alone) should be administered to all patients. A statin should be administered prior to PCI. IV β-blockers and IV NTG should be given in selected patients. Oral β-blockers should be initiated within the first day in patients without contraindications.
  • Image not available. Secondary prevention guidelines from the ACCF/AHA suggest that following MI from either STE MI or NSTE ACS, all patients, in the absence ...

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