NSTEMI infarction

Unstable Angina (UA) and Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) are important situations which may cause SCD or ML Treatment is aimed at the prevention of these events, mainly by revascularization after the immediate medical treatment. In this section, the medical therapy will be separately discussed for the hospital care and posthospital discharge care. 

ACS can be classified into UA, myocardial infarction (Ml) without ST-segment elevation [non-ST-elevation Ml (NSTEMI)], or STEMI. The presence of cardiac troponin in ACS indicates worse prognosis than the absence of troponin (9). 

Multiple biomarkers are under study. Well-studied and commercially available biomarkers include CK-MB, troponin I or T CRR and BNR and recently, myeloperoxidase, Each of these biomarkers is an independent predictor of death, myocardial infarction, or congestive heart failure. Utilizing the opus TIMI 16 patients, Sabatine et al. studied CRP BNP and troponin in 450 patients. These authors found a 30-day risk of death increased in proportion to the number of these biomarkers that were elevated at baseline (25). They validated the concept in the tactics TIMI 18 patients (26). These two trials of over 2000 patients with NSTEMI, troponin, CRR and BNP provided independent prognostic information. 

Abbreviations ACS, acute coronary syndrome ACT, activated clotting time BP, blood pressure CTO, chronic total occlusion i.v., intravenous MI, myocardial infarction NSTEMI, non-ST-segment elevation myocardial infarction PCI, percutaneous coronary intervention RCA, right coronaiy artery STEMI, ST-segment elevation myocardial ... 

Total loss of coronary blood flow results in a clinical syndrome associated with what is known as ST segment elevation AMI (STE AMI). Partial loss of coronary perfusion if severe also can lead to necrosis as well—which is generally less severe and is loiown as NSTEMI (non-ST-elevation myocardial infarction), and other events of still lesser severity may be missed entirely or called angina, which can range from stable to unstable. 

Abbreviations PCI = primary coronary intervention UA = unstable angina NSTEMI = non-ST-segment myocardial infarction Ml = myocardial infarction GP = glycoprotein receptor UFH = unfractionated heparin LMWH = low-molecular-weight heparin. 

FIGURE 2.1 Algorithm for risk stratification and treatment of patients with acute coronary syndromes. (STEMI, ST-elevation myocardial infarction NSTEMI, non-STEMI.)... 

---