Acute coronary syndromes recurrent

The major goals for the treatment of ischemic heart disease are to prevent acute coronary syndromes and death, alleviate acute symptoms of myocardial ischemia, prevent recurrent symptoms of myocardial ischemia, and avoid or minimize adverse treatment effects. 

Patients with acute coronary syndromes such as acute myocardial infarction and unstable angina remain at risk for recurrent myocardial ischemia despite therapy with antiplatelet agents and heparin. Although first clinical trials indicate a possible use of oral direct TIs for the prevention of cardiovascular events in patients after acute myocardial infarction, the presently available data are still limited and it has not... 

I The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation, N Engl J Med 2001 345 494-502. 

Cuisset T Frere C, Quilici J, et al, High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome, J Thromb Haemost 2006 4 542-549. 

Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes the MIRACL study a randomized controlled trial. JAMA 2001 285 171 I-171 8. 

Peters R, Mehta SR, Fox KA, et al. Clopidogrel in unstable angina to prevent recurrent events (CURE) trial investigators. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes observations from the clopidogrel in unstable angina to prevent recurrent events (CURE) study, Circulation 2003 108(14) 1682-1687. 

Based on a retrospective study of 344 patients with cocaine-associated chest pain, it has been suggested that patients who do not have evidence of ischemia or cardiovascular complications over 9-12 hours in a chest-pain observation unit have a very low risk of death or myocardial infarction during the 30 days after discharge (59). Nevertheless, patients with cocaine-associated chest pain should be evaluated for potential acute coronary syndromes those who do not have recurrent symptoms, increased concentrations of markers of myocardial necrosis, or dysrhythmias can be safely discharged after 9-12 hours of observation. A protocol of this sort should incorporate strategies for treating substance abuse, since there is an increased likelihood of non-fatal myocardial infarction in patients who continue to use cocaine. 

Suspected cardiac source at high risk of recurrent embolism prosthetic mechanical heart valve, endocarditis, aortic dissection, acute coronary syndrome, overt congestive heart failure... 

In the United States, approximately 700,000 patients suffer from an initial AMI annually and another 500,000 from a recurrent AMI. Coronary heart disease causes 20% of all deaths in the United States and cardiovascular diseases up to 38.5%. About 1.7 million patients are hospitalized each year in the United States with an acute coronary syndrome (ACS). Historically, most deaths caused by ischemic heart disease were acute, but as our therapeutic abfiities have increased, the disease is slowly becoming a more chronic one. When deaths occur acutely, they are caused by either... 

Akkerhuis KM, Klootwijd PA, Lindeboom W et al. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events meta-analysis of three studies involving 995 patients. Eur Heart J 2001 22 1997. 

Following interventional procedures such as PTCA, catheterization with angiography can be used to evaluate efficacy of the intervention. In recurrent clinical syndromes, following a procedure, catheterization is used to help delineate a new management strategy. Catheterization is also now used commonly with PTCA and/or drug therapy in the management of acute coronary syndromes. 

Acute coronary syndromes (ACS) encompass a wide spectrum of coronary artery disease from unstable angina (UA) to myocardial infarction (MI). According to the 2007 report from the American Heart Associations and Stroke Statistics Committee, about 700,000 Americans are expected to suffer from their first MI yearly, with almost 500,000 recurrent Mis occurring annually (1). Coronary heart disease (CHD) is responsible for about one out of every five deaths in the United States ACS is the cause of over 1.5 million hospitalizations yearly and therefore plays a significant role in the cost of our health care. 

The ATLAS ACS-TIMI 46 study was a phase n dose-escalation study of the use of rivaroxaban in preventing recurrent thrombosis in patients with acute coronary syndrome [48 ]. Patients who were taking aspirin as the sole antiplatelet therapy were randomized to either placebo or rivaroxaban 5,10, or 20 mg/day, while patients who were taking dual antiplatelet therapy took either placebo or rivaroxaban 5, 10, 15, or 20 mg/day. There was a dose-related increase in the risk of clinically significant... 

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