Faculty of Medicine Gadjah Mada University – Sardjito Hospital Yogyakarta Acute Coronary Syndromes Summary of Recommendations for Early Hospital Care
J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017
*Short-acting dihydropyridine calcium channel antagonists should be avoided.
J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017
Summary of Recommendations for Prognosis: Early Risk Stratification
J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017
6
TIMI Risk Score UA / NSTEMI
HISTORICAL POINTS RISK OF CARDIAC EVENTS (%) Age 65 1 BY 14 DAYS IN TIMI 11B* RISK DEATH DEATH, MI OR 3 CAD risk factors (FHx, HTN, chol, DM, active smoker) 1 SCORE OR MI URGENT REVASC
Known CAD (stenosis 50%) 1 0/1 3 5
ASA use in past 7 days 1 2 3 8 PRESENTATION 3 5 13 Recent ( 24H) severe angina 1 4 7 20 cardiac markers 1 5 12 26 ST deviation 0.5 mm 1 6/7 19 41 RISK SCORE = Total Points (0 - 7) * Entry criteria:UA or NSTEMI defined as ischemic pain Low = 0-2 points, Medium = 3-4 points at rest within past 24H, with evidence of CAD (ST segment High = 5-7 points deviation or +marker) 7 Algorithm for Management of Patients With Definite or Likely NSTE-ACS* Factors Associated With Appropriate Selection of Early Invasive Strategy or Ischemia-Guided Strategy in Patients With NSTE-ACS Summary of Recommendations for Initial Antiplatelet/Anticoagulant Therapy in Patients With Definite or Likely NSTE-ACS and PCI *The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily Dosing of Parenteral Anticoagulants During PCI *CrCl should be calculated for all older pts because SCr level does not accurately reflect renal dysfunction: CrCl decreases with age 0.7 mL/min/y. †These agents are not approved for NSTE-ACS but are included for management of pts with nonvalvular chronic atrial fibrillation. Conclusion • ACS is divided into STEMI and NSTE-ACS • The new paradigm of management of NSTE-ACS is early invasive strategy • Early risk stratification is important for NSTE-ACS prognosis • Early invasive strategy (PCI) require different antithrombotic treatment strategies • Antithrombotic agents composed DAPT and parenteral anticoagulants