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Each year, acute coronary syndrome (ACS) affects more than 7 million people globally. 1 ST-segment elevation myocardial infarction (STEMI) is responsible for 30% of cases, whereas non–ST-segment elevation ACS (NSTE ACS) accounts for the remaining 70%. 2 Common risk factors include being at least 65 years of age or a current smoker or having hypertension, diabetes mellitus, hyperlipidemia, a body mass index greater than 25 kg per m2, or a family history of premature coronary artery disease (CAD). 3 The most common symptom of ACS is acute chest pain, which accounts for approximately 1% of primary care visits and 5% of emergency department visits each year. 4,5
WHAT'S NEW ON THIS TOPIC
Acute Coronary Syndrome
| The 2021 American College of Cardiology and American Heart Association guidelines no longer recommend classifying chest pain as atypical or typical, because this classification is not useful for identifying the cause and has been misused to classify chest pain as benign. Instead, the guidelines now recommend that chest pain be classified as cardiac, possibly cardiac, or noncardiac. |
| A systematic review of home-based cardiac rehabilitation studies demonstrated higher patient adherence to home-based cardiac rehabilitation, and that home-based and outpatient cardiac rehabilitation achieved similar improvement in functional capacity, quality of life, and coronary artery disease risk factor control after 12 months. |
| Despite the high prevalence of depression in patients with acute coronary syndrome, evidence suggests that there is minimal benefit to screening for depression in patients who have had a myocardial infarction within the past 12 months. |
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendations | Evidence rating | Comments |
|---|---|---|
| Patients who present for acute chest pain and a high suspicion for acute coronary syndrome should be referred to the emergency department, where the evaluation should use predictive risk scores to aid in the prognosis, diagnosis, and management. This evaluation should include 12-lead electrocardiography within 10 minutes of presentation, history and physical examination, and high-sensitivity cardiac troponin measurement at initial presentation and three hours after symptom onset. 2,7,8,11 | C | Expert opinion and consensus guidelines |
| Patients diagnosed with ST-segment elevation myocardial infarction should receive coronary angiography, followed by PCI with a drug-eluting stent within 120 minutes of presenting to the emergency department. When PCI is not available, fibrinolytics can be administered if no... |