Acute coronary syndrome (unstable angina and non-ST elevation MI)
Michael L Sarkees1, Anthony A Bavry
1Cleveland Clinic, Cleveland, OH, USA.
Insights
This systematic review examines treatments for acute coronary syndrome (ACS). It found 32 studies on antiplatelet, antithrombin, and other therapies, evaluating their effectiveness and safety for ACS patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Evidence-Based Medicine
Background:
- Acute coronary syndrome (ACS) carries significant risks of death, myocardial infarction, and refractory angina within the first 30 days.
- Mortality rates in the year following ACS diagnosis range from 5-14%, with a notable proportion of deaths occurring early.
Purpose of the Study:
- To systematically review the effects of various treatments for acute coronary syndrome (ACS).
- To assess the effectiveness and safety of antiplatelet, antithrombin, anti-ischaemic, lipid-lowering, and invasive therapies for ACS.
Main Methods:
- Conducted a systematic review of medical literature up to May 2007.
- Searched major databases including Medline, Embase, and The Cochrane Library.
- Included harms alerts from regulatory agencies like the FDA and MHRA.
Main Results:
- Identified 32 systematic reviews, randomized controlled trials (RCTs), and observational studies meeting inclusion criteria.
- Evaluated a range of interventions including aspirin, clopidogrel, heparin, statins, and invasive procedures.
Conclusions:
- Presents comprehensive information on the effectiveness and safety of multiple interventions for ACS.
- Covers treatments such as aspirin, beta-blockers, statins, heparin, and early cardiac catheterization and revascularization.
Introduction:
In people with acute coronary syndrome (ACS) the incidence of serious adverse outcomes (such as death, acute myocardial infarction [MI], or refractory angina requiring emergency revascularisation) is 5-10% within the first 7 days and about 15% at 30 days. Between 5-14% of people with acute coronary syndrome die in the year after diagnosis, with about half of these deaths occurring within 4 weeks of diagnosis.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antiplatelet; antithrombin; anti-ischaemic; lipid-lowering; and invasive treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
Conclusions:
In this systematic review we present information relating to the effectiveness and safety of the following interventions: aspirin, beta-blockers, calcium channel blockers, clopidogrel, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors (oral or intravenous), heparin (low molecular weight, unfractionated), nitrates, routine early cardiac catheterisation and revascularisation, statins, and warfarin.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Angina II: Classification
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management