Advertisement

Interventional Treatment of Acute Coronary Syndrome (ACS): Non-ST Elevation ACS (NSTE-ACS)

  • Piera CapranzanoEmail author
Chapter

Abstract

Cardiovascular disease, of which coronary artery disease (CAD) is the prevalent manifestation, is the most common cause of death for both genders in industrialized countries; women develop CAD nearly a decade later in life. Across the entire spectrum of CAD, acute coronary syndromes (ACSs), characterized by acute plaque rupture or erosion with sudden coronary blood flow impairment, are associated with the highest rates of adverse clinical events. Among ACSs, the non-ST elevation ACS (NSTE-ACS), including non-ST elevation MI (NSTEMI) or unstable angina, is more frequent than ST elevation acute myocardial infarction (STEMI). While hospital mortality is higher in patients with STEMI than among those with NSTE-ACS, at 6 months, the mortality rates are similarly high in both clinical conditions and are higher among patients with NSTE-ACS at longer-term follow-up, most likely due to the more widely heterogeneous and worse overall risk profile of patients with NSTE-ACS. These latter epidemiological data suggest the need for defining optimal acute and chronic treatment strategies for NSTE-ACS.

Keywords

Percutaneous Coronary Intervention Acute Coronary Syndrome Coronary Artery Bypass Grafting Obstructive Coronary Artery Disease Invasive Strategy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Redfors B, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Dworeck C, Odenstedt J, Ioaness D, Ravn-Fischer A, Wellin P, Sjöland H, Tokgozoglu L, Tygesen H, Frick E, Roupe R, Albertsson P, Omerovic E. Trends in gender differences in cardiac care and outcome after acute myocardial infarction in Western Sweden: a report from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). J Am Heart Assoc. 2015;4(7).Google Scholar
  2. 2.
    Lansky AJ, Ng VG, Maehara A, Weisz G, Lerman A, Mintz GS, De Bruyne B, Farhat N, Niess G, Jankovic I, Lazar D, Xu K, Fahy M, Serruys PW, Stone GW. Gender and the extent of coronary atherosclerosis, plaque composition, and clinical outcomes in acute coronary syndromes. JACC Cardiovasc Imaging. 2012;5:S62–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, Simes RJ, White HD, Van de Werf F, Topol EJ, Hochman JS, Newby LK, Harrington RA, Califf RM, Becker RC, Douglas PS. Sex differences in mortality following acute coronary syndromes. JAMA. 2009;302:874–82.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, Brogan GX Jr, Boden WE, Roe MT, Ohman EM, Gibler WB, Newby LK. CRUSADE Investigators. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the American College of Cardiology/American Heart Association Guidelines) National quality improvement initiative. J Am Coll Cardiol. 2005;45:832–37.Google Scholar
  5. 5.
    Ahmed B, Dauerman HL. Women, bleeding, and coronary intervention. Circulation. 2013;127:641–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Rao SV, Hess CN, Barham B, Aberle LH, Anstrom KJ, Patel TB, Jorgensen JP, Mazzaferri Jr EL, Jolly SS, Jacobs A, Newby LK, Gibson CM, Kong DF, Mehran R, Waksman R, Gilchrist IC, McCourt BJ, Messenger JC, Peterson ED, Harrington RA, Krucoff MW. A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. JACC Cardiovasc Interv. 2014;7:857–67.CrossRefPubMedGoogle Scholar
  7. 7.
    Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.Google Scholar
  8. 8.
    Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ, ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–426.Google Scholar
  9. 9.
    De Carlo M, Morici N, Savonitto S, Grassia V, Sbarzaglia P, Tamburrini P, Cavallini C, Galvani M, Ortolani P, De Servi S, Petronio AS. Sex-related outcomes in elderly patients presenting with non-ST-segment elevation acute coronary syndrome: insights from the Italian Elderly ACS Study. JACC Cardiovasc Interv. 2015;8:791–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Cardiovascular DepartmentFerrarotto Hospital, University of CataniaCataniaItaly

Personalised recommendations