
Contents
42 Percutaneous coronary interventions in acute coronary syndromes
Get access-
Published:February 2021
-
This version:June 2023
Cite
Abstract
Acute coronary syndromes (ACS) remain the most common disease in acute cardiovascular care. Historically, two groups of patients should be differentiated based on initial ECG features: patients with ongoing chest pain and persistent ST-segment elevation and patients with acute chest pain but no persistent ST-segment elevation. The first condition is defined as STEMI and requires immediate reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolytic therapy. The second condition is defined as NSTE-ACS and consists of a big spectrum of cases ranging from patients free of symptoms at presentation to individuals with ongoing ischaemia, electrical or haemodynamic instability, mechanical complications such as severe mitral regurgitation, or cardiac arrest. The different types of ACS must be differentiated as their prognosis and therapeutic strategy varies. However, over the last years, the early and broad use of PCI as well as innovations in the adjunctive antithrombotic medication, including more effective P2Y12-inhibitors and new generation DES resulted to a dramatic improvement of the prognosis across the whole spectrum of ACS patients.
Update:
An early invasive strategy within 24 hours is recommended in the NSTE-ACS patient with any of the following high-risk criteria:
Established ...More
Update:
An early invasive strategy within 24 hours is recommended in the NSTE-ACS patient with any of the following high-risk criteria:
Established NSTEMI diagnosis.
Dynamic ST–T changes suggesting ongoing ischaemia.
Transient ST elevation.
GRACE score >140.
A selective invasive strategy is recommended in patients with no recurrence of symptoms and none of the very high- or high-risk criteria. The invasive strategy should be mainly driven by appropriate non-invasive ischaemia testing.
Prasugrel should be considered in preference to ticagrelor for NSTE-ACS patients who proceed to PCI.
Complete revascularization should be considered in STEMI patients with multivessel disease before hospital discharge.
Sign in
Personal account
- Sign in with email/username & password
- Get email alerts
- Save searches
- Purchase content
- Activate your purchase/trial code
- Add your ORCID iD
Purchase
Our books are available by subscription or purchase to libraries and institutions.
Purchasing informationMonth: | Total Views: |
---|---|
October 2022 | 11 |
November 2022 | 2 |
December 2022 | 3 |
January 2023 | 10 |
February 2023 | 14 |
March 2023 | 22 |
April 2023 | 21 |
May 2023 | 15 |
June 2023 | 13 |
July 2023 | 8 |
August 2023 | 5 |
September 2023 | 7 |
October 2023 | 8 |
June 2024 | 7 |
July 2024 | 1 |
Get help with access
Institutional access
Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:
IP based access
Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account.
Sign in through your institution
Choose this option to get remote access when outside your institution. Shibboleth/Open Athens technology is used to provide single sign-on between your institution’s website and Oxford Academic.
If your institution is not listed or you cannot sign in to your institution’s website, please contact your librarian or administrator.
Sign in with a library card
Enter your library card number to sign in. If you cannot sign in, please contact your librarian.
Society Members
Society member access to a journal is achieved in one of the following ways:
Sign in through society site
Many societies offer single sign-on between the society website and Oxford Academic. If you see ‘Sign in through society site’ in the sign in pane within a journal:
If you do not have a society account or have forgotten your username or password, please contact your society.
Sign in using a personal account
Some societies use Oxford Academic personal accounts to provide access to their members. See below.
Personal account
A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions.
Some societies use Oxford Academic personal accounts to provide access to their members.
Viewing your signed in accounts
Click the account icon in the top right to:
Signed in but can't access content
Oxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian.
Institutional account management
For librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more.