REVIEW

Contemporary management of acute coronary syndrome

G A Large

Correspondence to:
Correspondence to:
Dr G A Large
Department of Cardiovascular Medicine, University Hospital, Derby Road, Nottingham NG7 2UH, UK; adrian.large{at}virgin.net

This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe.

Abbreviations: ACS, acute coronary syndrome; NSTEACS, non-ST elevation acute coronary syndrome; TIMI, thrombolysis in myocardial infarction risks scoring system; CABG, coronary artery bypass grafting; UFH, unfractionated heparin; LMWH, low molecular weight heparin

Keywords: acute coronary syndrome; myocardial infarction; unstable angina

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