Division of Cardiovascular Medicine, Department of Medicine
Cardiology | Cardiovascular Diseases
Acute coronary syndrome is an umbrella term that is used to describe the abrupt reduction of blood flow to myocardial tissue, typically associated with the rupture of a coronary atherosclerotic plaque. Rupture exposes the blood to plaque contents, resulting in the deposition and activation of platelets and the formation of thrombi. Complete thrombotic occlusion produces ST-segment elevation myocardial infarction, whereas incomplete impairment of coronary blood flow results in unstable angina or, when biomarkers for myocardial injury are present, non–ST-segment elevation myocardial infarction (NSTEMI). Because the rupture of a plaque incites platelet activation and thrombosis, treatments for unstable angina and NSTEMI have focused on inhibiting platelet function and the coagulation cascade. In patients at high risk for future events (i.e., reinfarction or recurrent ischemia), an early invasive strategy of cardiac catheterization and revascularization is recommended, and in most of these patients intracoronary stents are implanted to treat the plaque rupture. Since stents can produce further plaque trauma, platelet-dependent thrombosis, and embolization into the coronary microcirculation, it is best practice to treat patients with agents that inhibit platelet activation to prevent recurrent ischemia after percutaneous coronary intervention (PCI). As a consequence, current guidelines recommend dual antiplatelet therapy with aspirin plus another agent in patients with NSTEMI who are undergoing PCI.
Cardiovascular Surgery, Coronary Disease/Myocardial Infarction, Acute Coronary Syndromes
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Copyright © 2013 Massachusetts Medical Society. Publisher PDF posted after 6 months as allowed by the publisher's author rights policy at https://www.nejm.org/page/author-center/permissions.
DOI of Published Version
N Engl J Med. 2013 Sep 12;369(11):1056-7. doi: 10.1056/NEJMe1308820. Epub 2013 Sep 1. Link to article on publisher's site
The New England journal of medicine
Keaney, John F. Jr., "P2Y12 inhibition in patients with NSTEMI--can later be better" (2013). Cardiovascular Medicine Publications and Presentations. 95.