Diagnosis of acute coronary syndrome
Suraj A Achar1, Suriti Kundu, William A Norcross
1University of California, San Diego, School of Medicine, La Jolla, California 92037-0968, USA. sachar@ucsd.edu
Insights
Acute coronary syndrome (ACS) diagnosis relies on ECG and ischemia symptoms. Risk stratification guides patient management, with troponin as a key biomarker for identifying acute myocardial infarction.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Acute coronary syndrome (ACS) is a spectrum of thrombotic coronary artery diseases.
- Includes unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI).
- Diagnosis hinges on electrocardiogram (ECG) findings and clinical signs of cardiac ischemia.
Purpose of the Study:
- To outline diagnostic criteria and risk stratification for acute coronary syndrome.
- To discuss the role of cardiac biomarkers and ECG abnormalities in ACS management.
- To explore future diagnostic modalities for optimizing patient care and reducing hospitalizations.
Main Methods:
- Electrocardiogram (ECG) interpretation for ischemic changes (T-wave abnormalities, ST elevation/depression, Q waves).
- Clinical assessment of signs and symptoms of cardiac ischemia.
- Biomarker analysis, including troponin T/I and creatine kinase-MB, for myocardial injury detection.
Main Results:
- ECG abnormalities are crucial for diagnosing ACS.
- Risk stratification determines patient disposition: hospitalization for high-risk, structured evaluation for intermediate-risk, and discharge for low-risk patients.
- Troponin T or I is the most sensitive biomarker for ACS; myoglobin and CK-MB subforms are early markers.
Conclusions:
- Accurate diagnosis and risk stratification are essential for timely and appropriate management of acute coronary syndrome.
- Cardiac biomarkers, particularly troponin, play a vital role in confirming myocardial infarction.
- Advanced imaging techniques may improve diagnostic accuracy and reduce unnecessary hospital admissions in the future.
Abstract:
The term "acute coronary syndrome" encompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non-ST-segment elevation myocardial infarction. Diagnosis requires an electrocardiogram and a careful review for signs and symptoms of cardiac ischemia. In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. Risk stratification allows appropriate referral of patients to a chest pain center or emergency department, where cardiac enzyme levels can be assessed. Most high-risk patients should be hospitalized. Intermediate-risk patients should undergo a structured evaluation, often in a chest pain unit. Many low-risk patients can be discharged with appropriate follow-up. Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. Early markers of acute ischemia include myoglobin and creatine kinase-MB subforms (or isoforms), when available. In the future, advanced diagnostic modalities, such as myocardial perfusion imaging, may have a role in reducing unnecessary hospitalizations.
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