Acute coronary syndrome (main)

Background

ACS is three diseases involving the coronary arteries:

1. ST-Elevation Myocardial Infarction (STEMI) (30%)
2. Non ST-Elevation Myocardial Infarction (NSTEMI) (25%)
3. Unstable Angina (38%)

• ECG is normal in 8% of all confirmed MI's

Diagnosis

1. Angina is considered unstable with 1 or more:
   1. Occurs for 1st time
   2. Occurs at rest
   3. Accelerating frequency or severity

Stable Angina

1. Intensity of Rx should be based on likelihood that sx are due to acute coronary thombosis

ECG (Diagnosis)

ACS - Risk Stratification

TIMI RISK STRATIFICATION SCORE

1. 1 point for each
   1. Age ≥65 years
   2. Presence of at least three risk factors for CHD
   3. Prior coronary stenosis of ≥50 percent
   4. Presence of ST segment deviation on admission ECG
   5. At least two anginal episodes in prior 24 hours
   6. Elevated serum cardiac biomarkers
   7. Use of aspirin in prior seven days
2. Likelihood of mortality, new or recurrent MI, or require revascularization at 14 days
   1. Score of 0/1 - 4.7 percent
   2. Score of 2 - 8.3 percent
   3. Score of 3 - 13.2 percent
   4. Score of 4 - 19.9 percent
   5. Score of 5 - 26.2 percent
   6. Score of 6/7 - 40.9 percent

See Also

• ACS - Anatomical Correlation
• ACS - Risk Stratification
• ST-Elevation Myocardial Infarction (STEMI)
• ACS - Stress Testing
• NSTEMI
• Unstable Angina
• Stable Angina