Acute Coronary Syndromes

The management of non-ST segment elevation acute coronary syndromes (NSTE-ACS) has rapidly evolved over the last few years and many guidelines have been provided and already updated. This book is based on the latest ESC Guidelines and reports the current knowledge in NSTE-ACS, together with the most recent therapeutic options and the different strategies that can be applied according to the clinical status of patients.

International experts address the different aspects of NSTE-ACS and bring useful information to clinicians, interventionalists and surgeons involved in the difficult management of these patients.

The ESC Education Series
This book is part of the ESC Education Series. The series is designed to provide medical professionals with the latest information about the understanding, diagnosis and management of cardiovascular diseases. Where available, management recommendations are based on the established European Guidelines, which encompass the best techniques to use with each cardiac disease. Throughout the series, the leading international opinion leaders have been chosen to edit and contribute to the books. The information is presented in a succinct and accessible format with a clinical focus.

List of contributors viii

Preface x

Section one: Epidemiology

Chapter 1 Epidemiology of non-ST-segment elevation acute coronary syndromes 3
David Hasdai and Alexander Battler

Section two: Pathophysiology

Chapter 2 Pathologic findings in acute coronary syndromes 11
Erling Falk

Chapter 3 Vascular biology of acute coronary syndromes 24
Lina Badimon

Section three: Clinical aspects of ACS

Chapter 4 Clinical aspects of acute coronary syndromes 43
Eugene McFadden

Chapter 5 Circulating biomarkers for risk stratification 52
Christopher Heeschen

Section four: Investigation in ACS

Chapter 6 Coronary angiography angioscopy and intravascular ultrasound in non-ST-segment elevation acute coronary syndromes 65
Eric Van Belle Christophe Bauters François Schiele and Michel E. Bertrand

Chapter 7 New coronary imaging in acute coronary syndrome 78
Pim J. de Feyter Evelyne Regar and Nico R.A. Mollet

Section five: Special groups of patients

Chapter 8 Acute coronary syndromes in specialgroups of patients 97
Piero O. Bonetti Michael J. Zellweger Christoph Kaiser and Matthias E. Pfisterer

Section six: Pharmacological treatment

Chapter 9 Antiischemic treatment (nitrates β-blockers calcium antagonists) 109
David McCarty Colum G. Owens and A.A. Jennifer Adgey

Chapter 10 Antiplatelet therapies: aspirin thienopyridines and glycoprotein IIb/IIIa receptor inhibitors 116
Jaydeep Sarma and Keith A.A. Fox

Chapter 11 Antithrombin drugs: LMWH unfractionated heparin direct thrombin inhibitors 139
Raphaelle Dumaine and Gilles Montalescot

Chapter 12 Statin therapy in ACS 152
François Schiele

Section seven: Myocardial revascularization

Chapter 13 Percutaneous coronary interventions and stenting/CABG in non-ST-segment elevation acute coronary syndromes 165
Nicolas Meneveau and Jean-Pierre Bassand

Section eight: Therapeutic strategy

Chapter 14 Risk stratification and therapeutic strategy 187
Christian W. Hamm

Chapter 15 Indication for revascularization in non-ST-elevation acute coronary syndrome 199
Lars Wallentin

Chapter 16 Management of patients with nonamenable lesions for myocardialrevascul arization 211
Victor Legrand

Chapter 17 Non-ST-segment elevation coronary syndromes: European Society of Cardiology guidelines 225
Michel E. Bertrand

Chapter 18 Non-ST-segment elevation acute coronary syndromes: ACC/AHA guidelines 236
Pierre Théroux

Chapter 19 From guidelines to registries 248
Luigi Tavazzi

Section nine: Secondary prevention

Chapter 20 Secondary prevention after acute episode of patients presenting with nonpersistent ST-segment elevation 261
Michel E. Bertrand

Chapter 21 How to detect vulnerable plaque 270
Dirk Boese and Raimund Erbel

Chapter 22 Localversus systemic prevention treatment 281
Mario Togni and Bernhard Meier

Conclusions 294

Index 295

Michael Bertrand, Emeritus Professor of Cardiology, Lille Heart Institute, Lille, France

Dr Spencer King III, Fuqua Chair of Interventional Cardiolo, Fuqua institute, Atlanta, GA, USA

Acute coronary syndromes: A handbook for clinical practice is part of the ESC Education Series. The series is designed to provide medical professionals with the latest information about the understanding, diagnosis and management of cardiovascular diseases. Management recommendations in this book are based on the established European Guidelines, which encompass the best techniques to use with each cardiac disease you are faced with. Throughout the series, leading international opinion leaders have been chosen to edit and contribute to the books.

Acute coronary syndromes: A handbook for clinical practice is a concise, yet comprehensive overview of these frequent coronary events.

During the last decade, research on acute coronary syndromes has exploded and major advances have been made in the diagnosis, risk stratification and management of these patients. This is mainly due to the enormous incidence of acute coronary syndromes, but also because the prognosis still remains critical even with the benefit of our modern strategies. This segment of cardiovascular medicine is a rapidly evolving field and, with contributions from both North American and European experts, this book ensures that clinicians, interventional cardiologists and surgeons are all fully acquainted with the latest developments in acute coronary syndromes.