[Anti-ischemic therapy in patients with STEMI or NSTEMI treated at county and university hospitals]
Vjekoslava Raos1, Miroslav Raguz, Ivana Rajcan Spoljarić
1University Department of Medicine, Dubrava University Hospital, Zagreb, Croatia.
Insights
Prompt diagnosis and treatment of acute coronary syndromes (ACS) are crucial. Effective prehospital and in-hospital care, including reperfusion therapy and anti-ischemic drugs, reduces pain, prevents complications, and improves patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Context:
- Acute Coronary Syndromes (ACS), encompassing ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA), require immediate medical attention.
- Prehospital care focuses on rapid diagnosis, risk assessment, pain management, and early intervention to prevent heart failure.
- In-hospital treatment involves reperfusion strategies, limiting infarct size, and managing complications like arrhythmias and heart failure.
Purpose:
- To outline the objectives and therapeutic procedures for managing patients with ACS in both prehospital and in-hospital settings.
- To review the efficacy of various anti-ischemic agents and reperfusion therapies, including primary percutaneous coronary intervention (PCI) and thrombolytic therapy.
- To present key findings from major clinical studies and established guidelines for anti-ischemic therapy in ACS.
Summary:
- For STEMI patients presenting within 3-12 hours, primary PCI is recommended. Within 3 hours, thrombolytic therapy is as effective as PCI.
- A range of anti-ischemic drugs, including nitrates, morphine, oxygen, beta-blockers, calcium channel blockers, ACE inhibitors, magnesium, and glucose-insulin-potassium, are proven effective.
- These agents reduce myocardial oxygen consumption through decreased heart rate, blood pressure, and contractility, while improving oxygen supply via vasodilation.
Impact:
- Optimal management of ACS reduces patient suffering, prevents life-threatening complications, and decreases the risk of reinfarction and sudden cardiac death.
- Adherence to established guidelines for reperfusion and anti-ischemic therapy improves clinical outcomes and long-term prognosis for ACS patients.
- This comprehensive approach to ACS care underscores the importance of timely diagnosis and evidence-based treatment strategies.
Abstract:
The objective of prehospital care of patients with acute coronary syndrom (ACS) [acute ST segment elevation myocardial infarction (STEMI), acute non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA)], is prompt diagnosis of the acute myocardial infarction, patient's risk assessment, drug administration in order to reduce patient's pain and fear, and prevention or treatment of heart failure. In hospital treatment therapeutic procedures include reperfusion therapy, limitation of infarction zone, treatment of complications (heart failure, life-threatening arrhythmias), prevention of reinfarction, heart failure and eventually prevention of sudden cardiac death. Acute therapeutic procedures include revascularization, anti-ischemic and antithrombolytic treatment, possible surgical revascularization and treatment of complications (arrhythmias, heart failure). The patients with STEMI that present within 3-12 hours from the onset of chest pain should undergo primary percutaneous coronary intervention (PCI). In case of presentation within 3 hours from the occurrence of chest pain, the administration of thrombolytic therapy in this period is equally efficient as PCI. Regardless of reperfusion regimen, the anti-ischemics administered including nitrates (nitroglycerin); intravenous analgesics (morphine-sulfate); O2 2-4 L/min; beta-adrenergic blockers; calcium channel blockers; angiotensin converting enzyme inhibitors (ACE-I); magnesium and glucose-insulin-potassium have proved to be efficient as shown by study results and clinical experience. The mechanism of action of anti-ischemics includes reduction in myocardial oxygen consumption achieved by a decrease of heart frequency, reduction of systemic blood pressure and reduction in myocardial contractility by vasodilatation and consequent better myocardial oxygen supply. The outstanding results of major clinical studies are presented, and main guidelines for anti-ischemic therapy of ACS adopted by the international professional associations are set forth.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:14Myocarditis III: Medical Management