Almanac 2011: acute coronary syndromes. The national society journals present selected research that has driven recent advances in clinical cardiology

摘要: This overview highlights some recent advances in the epidemiology, diagnosis, risk stratification and treatment of acute coronary syndromes. The sheer volume new studies reflects robust state global cardiovascular research but focus here is on findings that are most interest to practising cardiologist. Incidence mortality rates for myocardial infarction decline, probably owing a combination lifestyle changes, particularly smoking cessation, improved pharmacological interventional treatment. Troponins remain central diagnosis high-sensitivity assays further lowering detection thresholds improving outcomes. incremental diagnostic value other circulating biomarkers remains unclear simple clinical algorithms such as GRACE score have proved more useful. Primary PCI with minimal delay effective reperfusion strategy ST elevation (STEMI). Radial access associated less bleeding than femoral approach, outcomes appear similar. Manual thrombectomy limits distal embolisation infarct size while drug-eluting stents reduce need revascularisation procedures. Non-culprit disease best dealt electively staged procedure after primary has been completed. development antithrombotic antiplatelet regimens continues evolve, indications fondaparinux bivalirudin well small-molecule glycoprotein (GP)IIb/IIIa inhibitors. If timely unavailable, fibrinolytic an option early angiographic assessment recommended all patients. Non-ST segment (NSTEMI) now dominant phenotype phase significantly worse STEMI. Many patients NSTEMI undertreated there large body work seeking define this group patients. benefits invasive …