Acute Coronary Syndromes in Clinical Practice

This useful booklet presents a complete assessment of the epidemiology and medical presentation of acute coronary syndromes (ACS). It additionally publications the reader via probability evaluation, chance stratification, analysis, and therapy of ACS.

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Unfortunately, patients who present with a left bundle branch block have worse outcomes when compared with those who have interpretable electrocardiograms. While a left bundle branch block is usually the result of an extensive myocardial infarction, these patients are slow to be diagnosed and therefore experience delays in receiving reperfusion therapy. 4) [16]. These consist of: • 1 mm or more of ST-depression in V1 to V3; • 5 mm of ST-elevation discordant to the QRS complex; • 1 mm of ST-elevation concordant to the QRS complex.

Circulation 2002; 106:379–385. 24. Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA 2000; 284:1549–1558. 25. Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomized clinical trials. Lancet 2002; 359:189–198. 26. Roffi M, Chew DP, Mukherjee D, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes.

This model is somewhat more cumbersome than the TIMI risk model in that there is a wide range of possible points for each variable. 4 PURSUIT risk score for predicting short-term adverse outcomes among patients with non-ST-elevation ACS 30-day mortality (%) 25 50 20 40 15 30 10 20 5 10 0 30-day mortality or nonfatal (re)infarction (%) 0 0 4 8 12 16 20 Risk score Score Mortality only Mortality or infarction 0 2(3) 4 (6) 6 (9) 8 (11) 9 (12) 11 (13) 12 (14) Gender Female Male 0 1 0 1 Worst CCS-class in previous 6 weeks No angina; I or II III or IV 0 2 0 2 0 1 (2) 2 (5) 0 0 0 Systolic blood pressure (mmHg) No Yes 0 3 0 1 Signs of heart failure (rales) No Yes 0 3 0 2 ST depression on presenting ECG No Yes 0 3 0 1 Age 50 60 70 80 Heart rate (bpm) 80 100 120 bpm, beats per minute; CCS, Canadian Cardiovascular Society; ECG, electrocardiogram; PURSUIT, Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy.

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