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Tag Archives: NSTEMI

Acute coronary syndrome in adults: scope of the problem in the UK

September 2017 Br J Cardiol 2017;24(suppl 1):S3–S9 doi:10.5837/bjc.2017.s01

Acute coronary syndrome in adults: scope of the problem in the UK

Chris P Gale

Abstract

Definition of ACS Acute coronary syndromes (ACS) include unstable angina and acute myocardial infarction (AMI). AMI is classified according to those patients with electrocardiographic ST-segment elevation, ST-elevation myocardial infarction (STEMI) and those without electrocardiographic ST-segment elevation, non-ST-elevation myocardial infarction (NSTEMI).1 The requirement for a diagnosis of AMI in the universal definition is the detection of troponin release from injured cardiac myocytes with at least one value >99th centile of the upper reference limit.1 Diagnosis is confirmed only if this is associated with at least one of: symptoms of

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Dual antiplatelet therapy and upper gastrointestinal bleeding risk: do PPIs make any difference?

September 2013 Br J Cardiol 2013;20:148 doi:10.5837/bjc.2013.029

Dual antiplatelet therapy and upper gastrointestinal bleeding risk: do PPIs make any difference?

Inamul Haq, Fazal-ur-Rehman Ali, Shakeel Ahmed, Steven Lindsay, Sudantha Bulugahapitiya

Abstract

Introduction Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is recommended for up to one year following acute coronary syndrome (ACS) in order to reduce the risk of further cardiac events.1,2 Gastrointestinal bleeding is the main hazard of this treatment; however, although the incidence of bleeding is low, it results in significantly increased morbidity and mortality in these patients,3-5 and proton pump inhibitors (PPIs) are often prescribed to selective patients to reduce this risk. PPIs act by reducing the secretion of gastric acid, neutralising gastric pH, increasing clot formation and decreasing the lysis of blood clots. Th

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September 2010 Br J Cardiol 2010;17:s3-s4

PCI in the UK – the continuing journey

BJCardio staff

Abstract

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

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September 2010 Br J Cardiol 2010;17:s5-s8

Intervention: who to treat and how? 

BJCardio staff

Abstract

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

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September 2010 Br J Cardiol 2010;17:s9-s14

Optimising medical treatment of ACS

BJCardio staff

Abstract

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

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