p.2
Risk Stratification for NSTE-ACS
What indicates a high-risk classification in NSTE-ACS?
Rise or fall in cardiac troponin, dynamic ST- or T-wave changes, GRACE score >140, TIMI risk score >4.
p.2
Risk Stratification for NSTE-ACS
What are the very-high-risk criteria for NSTE-ACS?
Haemodynamic instability, recurrent chest pain, dynamic ST-T wave changes, life-threatening arrhythmias, acute heart failure, mechanical complications of MI.
p.16
Cardiac Troponin Interpretation
Is cTn elevation exclusive to Acute Coronary Syndrome (ACS)?
No, it may be present in 1% of a healthy reference population.
p.20
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What are the benefits of using accelerated hs-cTn diagnostic protocols?
They are cost-effective, reduce ED-length of stay, and are safe.
p.4
Classification of Myocardial Infarction
What causes Type 2 myocardial infarction (MI)?
An imbalance between myocardial oxygen demand and supply unrelated to acute coronary athero-thrombosis.
p.7
Classification of Myocardial Infarction
What are the two main components of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)?
Unstable angina (UA) and Non-ST elevation myocardial infarction (NSTEMI).
p.20
Cardiac Troponin Interpretation
What key clinical data should be considered when interpreting cTn?
Patient's chest pain features, past medical history, and ECG.
p.10
Risk Stratification for NSTE-ACS
What are the common causes of Acute Coronary Syndrome (ACS)?
Atherosclerotic plaque rupture, fissure or ulceration with superimposed thrombosis, and coronary vasospasm.
p.19
Diagnostic Criteria for Myocardial Injury and Infarction
What is the HEART pathway used for?
To rule out ACS using the HEART score and cTn levels.
p.4
Classification of Myocardial Infarction
What is Type 1 myocardial infarction (MI)?
Spontaneous MI due to coronary athero-thrombosis, related to atherosclerotic plaque rupture, leading to decreased myocardial blood flow.
p.11
Classification of Myocardial Infarction
What are the two types of myocardial infarction (MI) discussed in the guidelines?
Type 1 MI (related to atherosclerotic plaque rupture) and Type 2 MI (due to an imbalance between myocardial oxygen supply and/or demand).
p.20
Cardiac Troponin Interpretation
What do the cut-off levels for hs-cTn vary with?
The assays used, and some have sex-specific cut-off points.
p.4
Classification of Myocardial Infarction
What defines Type 4a myocardial infarction (MI) related to PCI?
Elevation of cardiac troponin values 5 times > 99th percentile URL in patients with normal baseline values, along with symptoms or new ischemic ECG changes.
p.4
Classification of Myocardial Infarction
How is Type 4b myocardial infarction (MI) identified?
Detected by coronary angiography or autopsy in the setting of myocardial ischemia with a rise and/or fall of cardiac biomarker values.
p.7
Classification of Myocardial Infarction
How is unstable angina (UA) classified according to Braunwald’s classification?
1. New onset of severe angina or accelerated angina; no rest pain, 2. Angina at rest, subacute, 3. Angina at rest, acute.
p.17
Diagnostic Criteria for Myocardial Injury and Infarction
What role does echocardiography play in the management of MI?
It assists in rapid diagnosis and management, detecting LV systolic function and complications of MI.
p.1
Diagnostic Criteria for Myocardial Injury and Infarction
What is required to diagnose Acute Myocardial Infarction (AMI) using troponin levels?
A rise and/or fall of troponins above the 99th percentile URL along with evidence of ischemia.
p.18
Cardiac Troponin Interpretation
What type of testing should hospitals have access to for patients with acute chest pain or suspected MI?
cTn (subtypes T or I) testing, preferably hs-cTn.
p.16
Cardiac Troponin Interpretation
What is the clinical impact of sex-based cut-off values for hs-cTn levels?
They had little clinical impact on the diagnosis of MI; the uniform 99th percentile should remain the standard of care.
p.14
Electrocardiography (ECG) in Diagnosis
What should be done if a new (or presumed new onset) LBBB is detected?
It should be treated as STEMI.
p.9
Risk Stratification for NSTE-ACS
How is NSTEMI differentiated from unstable angina (UA)?
NSTEMI shows detectable cardiac biomarkers due to sufficient myocardial injury, while UA does not.
p.13
Electrocardiography (ECG) in Diagnosis
When should an ECG be performed in relation to First Medical Contact (FMC)?
Within 10 minutes of FMC.
p.13
Clinical Guidelines and Recommendations
What should ambulances and clinics be equipped with for NSTE-ACS management?
12-lead ECG-capable devices with computer-generated interpretations.
p.8
Cardiac Troponin Interpretation
How should cardiac troponin (cTn) levels be interpreted?
cTn should always be interpreted in the clinical setting; elevations without a rise and fall are often myocardial injuries, not MI.
p.8
Mortality Rates in NSTE-ACS
What factors can lead to persistently elevated cTn levels?
Pre-existing coronary artery disease (CAD), impaired renal function, and being older than 75 years.
p.19
Risk Stratification for NSTE-ACS
What is the estimated test threshold for missed diagnosis of myocardial infarction (MI) in the ED?
Approximately 2% for ED patients presenting with suspected cardiac chest pain.
p.7
Mortality Rates in NSTE-ACS
What is the principal cause of death in Malaysia?
Ischemic Heart Disease (IHD).
p.10
Diagnostic Criteria for Myocardial Injury and Infarction
What characterizes Unstable Angina (UA)?
Myocardial injury is absent and cardiac biomarkers (cTn) are normal.
p.17
Cardiac Troponin Interpretation
What is the significance of the 99th percentile URL in cTn assays?
It is important for clinicians to be familiar with it for accurate interpretation of cTn results.
p.9
Electrocardiography (ECG) in Diagnosis
What is the role of ECG in diagnosing myocardial injury?
The ECG may be normal or show non-specific changes without typical ischemia/infarction features.
p.3
Pharmacotherapy Recommendations
What is the maintenance dose of Ticagrelor for NSTE-ACS?
90 mg twice daily, to be given as part of DAPT for at least 1 year.
p.14
Use of Cardiac Biomarkers
What is the advantage of hs-cTn assays over older cTn tests?
They detect cTn release at an earlier time point, improving early sensitivity for a diagnosis of MI.
p.21
Risk Stratification for NSTE-ACS
What endpoints are considered in the HEART score?
MI, revascularization by PCI or CABG, death, and a combined endpoint of AMI, PCI, CABG, and death.
p.8
Risk Stratification for NSTE-ACS
What is the significance of re-classifying UA patients in Braunwald’s Classification Stage III b to NSTEMI?
This re-classification increased the diagnosis of MI by 47% and is prognostically important as these patients will be treated more aggressively.
p.3
Pharmacotherapy Recommendations
What is the indication for Nitrates, CCB, Ivabradine, ranolazine, and trimetazidime in NSTE-ACS?
Indicated for residual/recurrent ischemia.
p.20
Clinical Guidelines and Recommendations
What should be done if a POC kit reading is elevated?
Admit the patient for further evaluation.
p.4
Classification of Myocardial Infarction
What characterizes Type 3 myocardial infarction (MI)?
Cardiac death with symptoms suggestive of myocardial ischemia when biomarker values are unavailable.
What leads to myocardial injury in the context of myocardial infarction (MI)?
Ischemia, which can lead to cell death and raised cardiac biomarkers.
p.18
Risk Stratification for NSTE-ACS
What is the definition of a low-risk patient for ACS safe for discharge from the ED?
A patient with a < 1% risk of MACE or death at ≥ 30-days follow-up.
p.10
Classification of Myocardial Infarction
How can myocardial infarction (MI) be classified?
Into 5 types based on pathology, clinical features, prognosis, and treatment strategies.
p.11
Diagnostic Criteria for Myocardial Injury and Infarction
What features increase the probability of ischemic chest pain?
Pain radiating to both arms, similar pain to prior ischemic episodes, change in pain pattern over 24 hours, and associations with sweating and exertion.
p.17
Cardiac Troponin Interpretation
How should elevations of cTn be interpreted?
They should be correlated with the clinical condition of the patient and the ECG.
p.14
Electrocardiography (ECG) in Diagnosis
What should be done with serial ECGs in ACS patients?
They should be performed as changes may evolve.
p.22
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What should be done for patients with mildly raised cTn levels and equivocal results?
They need proper evaluation and appropriate treatment while avoiding unnecessary admissions or invasive procedures.
p.3
Pharmacotherapy Recommendations
When should ACE-Is be started for patients with LVEF ≤40%, anterior infarcts, and diabetes?
On the first day and continued long-term (>1 year).
p.22
Clinical Guidelines and Recommendations
What lifestyle modifications should be advised for low-risk patients?
Dietary changes, regular exercise, and smoking cessation.
p.19
Diagnostic Criteria for Myocardial Injury and Infarction
What is the purpose of a 'rule out protocol' for ACS?
To evaluate patients with normal or non-diagnostic ECGs for possible or suspected NSTE-ACS.
p.16
Cardiac Troponin Interpretation
What can lead to myocardial injury and hs-cTn elevations?
Primarily cardiac disorders as well as non-cardiac disorders with cardiac involvement.
p.16
Clinical Guidelines and Recommendations
What is the recommended testing for hospitals caring for patients with acute chest pain or suspected MI?
Access to cTn, preferably hs-cTn (subtypes T or I) testing.
p.9
Diagnostic Criteria for Myocardial Injury and Infarction
What is the significance of identifying an intracoronary thrombus?
It is crucial for diagnosing myocardial infarction (MI) through angiography or autopsy.
p.20
Clinical Guidelines and Recommendations
What is recommended if a POC kit reading is normal but clinical suspicion is high?
Repeat the test after 6 hours.
p.14
Electrocardiography (ECG) in Diagnosis
What is the significance of ST-segment depression greater than 0.5 mm in ACS patients?
It is associated with a 10.5% incidence of death or reinfarction.
p.12
Diagnostic Criteria for Myocardial Injury and Infarction
What symptoms are more likely to indicate an ischemic origin?
Shoulder pain, sweating, and a higher symptom distress score.
p.13
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What are the consequences of NSTE-ACS?
Hypotension, heart failure, and arrhythmias.
p.16
Clinical Guidelines and Recommendations
What should clinicians be familiar with regarding cTn assays?
Their local cTn assays, whether point-of-care (POC) kits or lab-based.
p.18
Risk Stratification for NSTE-ACS
What characterizes a high-risk patient with typical history of ischemic pains?
They can be quickly triaged to the monitored area.
p.1
Diagnostic Criteria for Myocardial Injury and Infarction
What are the ischemic evidence criteria for diagnosing AMI?
Ischemic type chest pain lasting >30 mins, ECG changes of new ischemia, development of pathologic Q-waves, or imaging evidence of new loss of viable myocardium.
p.18
Use of Cardiac Biomarkers
What is a limitation of cardiac biomarkers in diagnosing MI?
They are not specific and need to be interpreted in the clinical context.
p.3
Pharmacotherapy Recommendations
What is the target LDL-C level for patients receiving high-intensity statins in NSTE-ACS?
LDL-C <1.8 mmol/L; the lower the better.
p.3
Pharmacotherapy Recommendations
What is the recommendation for ARBs in patients post NSTE-ACS?
Started on the first day and continued long-term (> 1 year) for patients with LVEF ≤40%, anterior infarcts, and diabetes.
p.19
Risk Stratification for NSTE-ACS
What are the possible outcomes for patients presenting with chest pain or equivalents?
Very low likelihood of NSTE-ACS, definite NSTE-ACS or STEMI, or possible/suspected NSTE-ACS.
p.16
Cardiac Troponin Interpretation
What is a significant issue with point-of-care (POC) kits for cTn testing?
They have lower analytical sensitivity and too wide CoV to detect cTn at the 99th percentile URL.
p.2
Risk Stratification for NSTE-ACS
What defines low-risk criteria in NSTE-ACS?
Any characteristics not mentioned in higher risk categories.
p.17
Diagnostic Criteria for Myocardial Injury and Infarction
How can hs-cTn be used to rule in myocardial infarction (MI)?
By showing a significant rise and/or fall of cTn with at least one value greater than the 99th percentile URL in combination with other clinical criteria.
p.12
Risk Stratification for NSTE-ACS
In which groups is the diagnosis of ACS more frequently missed?
Women, those presenting with dyspnea, those with a normal ECG, and those with comorbidities.
p.20
Risk Stratification for NSTE-ACS
What does a low-risk HEART score indicate?
High sensitivity, negative predictive value, and negative likelihood ratio for predicting short-term MACE.
p.21
Risk Stratification for NSTE-ACS
What is the risk of a major adverse event for a HEART score of 4-6?
20.3% risk of a major adverse event.
p.21
Risk Stratification for NSTE-ACS
What does a HEART score of ≤ 3 indicate?
Low risk - 2.5% risk of a major adverse event.
p.8
Classification of Myocardial Infarction
What is the difference between myocardial injury and myocardial infarction (MI)?
Myocardial injury may be due to ischemia or non-ischemic causes, while MI is myocardial injury specifically due to ischemia, defined as myocardial cell death from prolonged ischemia.
p.22
Diagnostic Criteria for Myocardial Injury and Infarction
What diagnostic modalities can be used for patients with ongoing chest pain?
Repeating ECG, echocardiography/POCUS, functional stress testing, and coronary angiography.
p.21
Clinical Guidelines and Recommendations
What group of patients warrants further observation and/or investigation?
Patients with ongoing/recurrent chest symptoms without significant ECG or cTn elevations.
p.10
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What is Acute Coronary Syndrome (ACS)?
A clinical spectrum of Ischemic Heart Disease (IHD) that develops due to an imbalance between myocardial oxygen demand and supply.
p.7
Mortality Rates in NSTE-ACS
What does the NCVD-ACS registry indicate about mortality rates?
In-hospital, 30-day, and 1-year mortality rates are still high, though lower than in previous years.
p.12
Risk Stratification for NSTE-ACS
Which groups are more likely to not present with chest pain in ACS?
Women, diabetics, and the elderly.
p.18
Cardiac Troponin Interpretation
How should the cTn result be reported?
The exact value should be stated, not just as positive or negative.
p.12
Clinical Guidelines and Recommendations
What should clinicians consider if a patient has symptoms compatible with ACS and no alternative cause is identified?
The need for further investigations.
p.4
Classification of Myocardial Infarction
What is the criterion for Type 5 myocardial infarction (MI) related to CABG?
Elevation of cardiac biomarker values 10 times > 99th percentile URL in patients with normal baseline values, along with new pathological Q waves or new LBBB.
p.14
Use of Cardiac Biomarkers
Why are other biomarkers like AST, LDH, CK, CKMB, and myoglobin not useful for the initial diagnosis of acute MI?
They have lower sensitivity and specificity compared to cardiac troponins.
p.12
Clinical Guidelines and Recommendations
What is the objective of the physical examination in ACS?
To identify possible etiologies such as aortic stenosis and signs of hypercholesterolemia.
p.9
Electrocardiography (ECG) in Diagnosis
What ECG changes may be present in NSTEMI?
ST/T changes may be present, whereas in UA they are usually absent or transient.
p.9
Cardiac Troponin Interpretation
What is the importance of the coefficient of variation (CoV) in cardiac assays?
Assays should have a CoV of < 10% at the 99th percentile URL for accurate diagnosis.
p.22
Cardiac Troponin Interpretation
What do elevated cTn/hs-cTn levels without a significant rise and fall indicate?
Typically seen in elderly patients with pre-existing CAD and high long-term mortality.
p.21
Risk Stratification for NSTE-ACS
What is the performance of the HEART score compared to TIMI and GRACE scores?
The HEART score outperformed the TIMI and GRACE scores in predicting 30-day MACE.
p.5
Mortality Rates in NSTE-ACS
What are the outcome measures for patients admitted with ACS?
In-hospital mortality and morbidity, readmission rates for cardiac-related events.
p.10
Classification of Myocardial Infarction
What are the components of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)?
Unstable angina (UA) and Non-ST elevation myocardial infarction (NSTEMI).
p.7
Risk Stratification for NSTE-ACS
What is the clinical spectrum of Ischemic Heart Disease (IHD) that develops due to an imbalance between myocardial oxygen demand and supply?
Acute Coronary Syndrome (ACS).
p.18
Cardiac Troponin Interpretation
What is essential for clinicians regarding local cTn assays?
They must be familiar with point of care (POC) kits or laboratory-based assays, the 99th percentile URL, and the lower limit of detection (LoD).
p.16
Cardiac Troponin Interpretation
What is a rare cause of false positive cTn results?
Analytical issues, including cross-reaction from other immuno-reactive proteins and some neuromuscular diseases.
p.17
Risk Stratification for NSTE-ACS
What does ruling out MI require beyond negative cTn results?
Consideration of other causes of chest pain and early outpatient assessment for possible stable CAD.
p.1
Cardiac Troponin Interpretation
What are some non-coronary causes of elevated troponin levels?
Global hypoxia, hypoperfusion, heart failure, myocarditis, pericarditis, viral myocarditis, stress cardiomyopathy, sepsis, renal failure, and toxicity.
p.3
Pharmacotherapy Recommendations
What is the recommended maintenance dose of Clopidogrel for NSTE-ACS?
75 mg daily, to be given as part of DAPT for at least 1 year.
p.14
Risk Stratification for NSTE-ACS
What is the prognosis of a missed diagnosis of ACS?
It carries a worse prognosis.
p.22
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What are the possible management options for patients with UA and negative cTn/hs-cTn?
They may be admitted, observed in the ED, or referred for an early outpatient consult.
p.8
Diagnostic Criteria for Myocardial Injury and Infarction
What does a rise and/or fall in cTn levels indicate?
A rise and/or fall in cTn levels indicates acute injury, while persistently elevated levels indicate chronic injury.
p.2
Risk Stratification for NSTE-ACS
What are the intermediate-risk criteria for NSTE-ACS?
Diabetes mellitus, LVEF <40%, early post-infarction angina, prior revascularization, GRACE score >109 and <140, TIMI risk score 3 & 4.
p.9
Cardiac Troponin Interpretation
What is the suggested criterion for defining an MI with cTn values above the 99th percentile?
A change in concentrations of >20% from baseline.
p.13
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What are some precipitating causes of NSTE-ACS?
Uncontrolled hypertension, anemia, thyrotoxicosis, and infection.
p.10
Diagnostic Criteria for Myocardial Injury and Infarction
According to the 4th Universal definition, how is myocardial infarction (MI) diagnosed?
By a significant rise and/or fall in cTn, with at least one value above the 99th percentile URL, and at least one clinical indicator such as chest pain, ECG changes, imaging evidence, or identification of an intracoronary thrombus.
p.11
Risk Stratification for NSTE-ACS
Why is Type 2 MI significant in the elderly?
It is an important cause of acute coronary syndrome (ACS) in older individuals.
p.13
Diagnostic Criteria for Myocardial Injury and Infarction
What physical examination findings indicate potential causes of chest pain?
Pericardial rub for pericarditis, tracheal shift for pneumothorax, low oxygen saturation for pulmonary embolism.
p.18
Use of Cardiac Biomarkers
Why are cardiac biomarkers, especially hs-cTn, important in diagnosing ACS?
They are very sensitive and can detect myocardial injury earlier than older assays.
p.18
Risk Stratification for NSTE-ACS
What is the role of risk scores in the evaluation of ACS?
To help rule out ACS when initial history, physical examination, and ECG are not reliable.
p.8
Use of Cardiac Biomarkers
What are the cardiac biomarkers of choice for diagnosing myocardial injury and MI?
Cardiac troponins (cTn), preferably high-sensitivity (hs-cTn).
p.3
Pharmacotherapy Recommendations
What is the recommendation for β-blockers in patients with LVEF ≤40% post NSTE-ACS?
Consider long-term therapy (> 1 year).
p.22
Risk Stratification for NSTE-ACS
What is the benefit of functional stress testing in intermediate risk patients?
It stratifies them to a near zero short-term risk of ACS.
p.19
Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)
What should be done for patients with definite NSTE-ACS or STEMI?
They should be admitted and managed accordingly.
p.19
Diagnostic Criteria for Myocardial Injury and Infarction
What does the ESC 3-hour pathway require for ruling out ACS?
Baseline hs-cTn at presentation < 99th percentile and specific conditions based on symptom onset.
p.19
Diagnostic Criteria for Myocardial Injury and Infarction
What does the ESC 1-hour pathway measure?
Baseline and absolute changes in hs-cTn levels within the first hour.
p.14
Electrocardiography (ECG) in Diagnosis
What ECG feature is associated with the highest 30-day incidence of death or reinfarction in ACS patients?
A combination of ST elevation (at least 0.5 mm in at least 2 contiguous leads) and ST depression (at least 0.5 mm in 2 contiguous leads) - (12.4%).
p.12
Diagnostic Criteria for Myocardial Injury and Infarction
What are some atypical symptoms of ACS?
Dyspnea, unexplained sweating, nausea and vomiting, syncope, fatigue, and epigastric discomfort.
p.9
Cardiac Troponin Interpretation
What change in cTn values is suggested for values below the 99th percentile?
A change of 50-60% from baseline is suggested to overcome biological and analytical variations.
p.7
Diagnostic Criteria for Myocardial Injury and Infarction
What distinguishes unstable angina (UA) from myocardial injury?
In UA, myocardial injury is absent and cardiac biomarkers (troponins-cTn) are normal.
p.21
Risk Stratification for NSTE-ACS
What does a HEART score of ≥ 7 indicate?
High risk - 72.7% risk of a major adverse event.
p.13
Electrocardiography (ECG) in Diagnosis
Why is an ECG important in the management of NSTE-ACS?
It supports diagnosis and provides prognostic information.
p.17
Risk Stratification for NSTE-ACS
What is a key message regarding the combination of history, physical examination, and ECG?
It may be insufficient to reliably rule in or rule out NSTE-ACS.
p.8
Diagnostic Criteria for Myocardial Injury and Infarction
According to the 4th Universal definition, how is MI diagnosed?
MI is diagnosed with a significant rise and/or fall in cTn, at least one value above the 99th percentile URL, and at least one clinical indicator such as chest pain, ECG changes, or imaging evidence.
p.1
Cardiac Troponin Interpretation
What are elevated cardiac troponin levels indicative of?
They can indicate Acute Coronary Syndrome (ACS), including STEMI and NSTE-ACS, or non-ACS conditions.
p.20
Risk Stratification for NSTE-ACS
What are some common 'rule out' risk scores for suspected ACS?
HEART Score, TIMI risk score, ADAPT-ADP, ASPECT, HFA/CSANZ rule.
p.14
Use of Cardiac Biomarkers
What are the most sensitive and specific biomarkers for myocardial injury?
Cardiac troponins (cTn) T and I.
p.17
Clinical Guidelines and Recommendations
Why is routine chest radiograph not advised for all patients with chest pain suspicious of ACS?
The decision should be individualized based on the patient's condition.
p.1
Cardiac Troponin Interpretation
What does 'stable' denote in the context of troponin levels?
A variation of ≤20% in troponin values in the appropriate clinical context.
p.1
Cardiac Troponin Interpretation
What are some analytical errors that can affect troponin testing?
Assay-based errors and sample-based errors, such as using hemolysed specimens.
p.21
Risk Stratification for NSTE-ACS
Why was the TIMI score not designed for undifferentiated patients with chest pain?
It was not designed for application to undifferentiated patients presenting with chest pain and suspected ACS.
p.13
Electrocardiography (ECG) in Diagnosis
What is the limitation of computer-generated ECG reports?
They have a wide variation in false-positive and false-negative results and should not be the sole means to diagnose ACS.
p.21
Cardiac Troponin Interpretation
What is the significance of hs-cTn algorithms in ruling out MI?
They have high sensitivity and Negative Predictive Value (NPV), reducing the need for further testing.
p.13
Risk Stratification for NSTE-ACS
What comorbid conditions are associated with poor prognosis in NSTE-ACS?
Lung disease, peripheral vascular disease, and left ventricular failure.
p.9
Electrocardiography (ECG) in Diagnosis
What characterizes STEMI on an ECG?
ST elevation of ≥ 1 mm in 2 contiguous leads or a new onset LBBB in the resting ECG.
p.17
Use of Cardiac Biomarkers
What are the most sensitive and specific biomarkers for myocardial injury?
Cardiac troponins (cTn), preferably hs-cTn, both T and I.
p.3
Pharmacotherapy Recommendations
What is the recommended maintenance dose of Prasugrel for NSTE-ACS?
10 mg daily, to be given as part of DAPT for at least 1 year.
p.11
Diagnostic Criteria for Myocardial Injury and Infarction
Is relief of symptoms after nitrate administration specific for angina pain?
No, it is not specific for angina pain.
p.3
Pharmacotherapy Recommendations
What anticoagulant is recommended for medically treated patients in NSTE-ACS?
UFH, LMWH, or Fondaparinux for 2-8 days or until hospital discharge.
p.22
Diagnostic Criteria for Myocardial Injury and Infarction
What does a systematic review in 2017 suggest about CTCA?
CTCA is appropriate in all settings of acute chest pain suspicious of ACS if available.
p.7
Classification of Myocardial Infarction
What are the classifications of unstable angina (UA) based on clinical circumstances?
Secondary, Primary, and Post-infarct.
What is the significance of collateral circulation in NSTE-ACS?
In NSTE-ACS, the thrombus may be non-occlusive or there may be complete thrombosis of a vessel that is well collateralized.
p.11
Diagnostic Criteria for Myocardial Injury and Infarction
What features reduce the probability that chest pain is ischemic?
Variation with respiration or position, localization to a point, pain reproduced on palpation, and sharp or stabbing pain.
p.1
Cardiac Troponin Interpretation
What is the significance of troponin levels rising and/or falling?
It may indicate acute myocardial injury or chronic myocardial injury depending on the clinical context.
p.8
Diagnostic Criteria for Myocardial Injury and Infarction
What indicates myocardial necrosis in cardiac troponin levels?
A level above the 99th percentile Upper Reference Limit (URL) is abnormal and indicative of myocardial injury.
p.22
Pharmacotherapy Recommendations
What medications should be started if the likelihood of underlying CAD is high?
Antiplatelet agents, high-intensity statins, and appropriate anti-ischemic therapy.
