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Acute coronary syndrome: pharmacotherapy
R O'Connor1, D Persse, B Zachariah
1Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware 19718, USA. roconnor@christianacare.org
Insights
Emergency medical services can optimize acute coronary syndrome (ACS) care by carefully selecting prehospital pharmacologic agents. Reviewing drug classes for clotting, hemodynamics, and pain relief ensures appropriate use in the field.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Acute coronary syndrome (ACS) encompasses a range of cardiac conditions, from unstable angina to ST-segment-elevation myocardial infarction.
- In emergency medical services (EMS), ACS management includes patients with symptoms suggestive of cardiac origin, confirmed ischemia, or myocardial infarction via electrocardiogram.
- Prehospital ACS care considers patients with prior cardiac events or known cardiac disease presenting with symptoms.
Framework:
- Pharmacologic management of ACS relies on three key drug classes: anticoagulants, hemodynamic stabilizers, and analgesics.
- Agents reviewed include aspirin, GPIIb/IIIa inhibitors, heparins, fibrinolytics, beta-blockers, calcium antagonists, nitrates, and morphine.
- Efficacy of these agents is established in hospital settings, with ongoing research in prehospital environments.
Implementation:
- Prehospital drug use depends on patient selection, need for immediate intervention, and ease of administration.
- EMS personnel expertise and cost-effectiveness are critical factors in implementing prehospital therapies.
- A consensus review assessed indications, prehospital applicability, and current use of various pharmacologic agents.
Implications:
- Optimizing prehospital pharmacotherapy can improve outcomes for patients with acute coronary syndrome.
- Evidence-based selection of medications is crucial for effective emergency cardiac care.
- Further research into prehospital efficacy will refine treatment protocols for ACS.
Abstract:
Acute coronary syndrome (ACS) refers to the spectrum of cardiac disease, from unstable angina to ST-segment-elevation myocardial infarction. In the emergency medical services (EMS) setting, ACS may be more broadly thought to include patients with chest pain or other symptoms believed to have a cardiac origin who have evidence of ischemia or acute myocardial infarction on a 12-lead electrocardiogram, or symptomatic patients with a previous cardiac event or known cardiac disease. Pharmacologic management of these patients is based on the use of three primary classes of drugs: those that affect clotting, those that establish and maintain hemodynamic control, and those that relieve pain. Many of these agents have been evaluated in large clinical trials for in-hospital use, and a number of ongoing studies are assessing their efficacy in the prehospital setting. The appropriateness of prehospital use of specific agents within each class depends on proper patient selection, the necessity of immediate intervention, ease of use in the field, expertise of EMS personnel, and cost-effectiveness of therapy. This consensus group reviewed agents from all three classes (including aspirin, GPIIb/IIIa inhibitors, unfractionated and low-molecular-weight heparins, fibrinolytics, beta-adrenergic blockers, calcium antagonists, nitrates, and morphine) for their overall indication, applicability to the prehospital setting, and current prehospital use.
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