摘要:

Acute coronary syndromes (ACS) represent a spectrum of disease, including unstable angina, non ST-elevation myocardial infarction, and ST-elevation myocardial infarction. In patients with cardiovascular disease, ACS represents the most common diagnosis for hospital admission, accounting for nearly 1.5 million hospital admissions in 1999. Similarly, although improvements in medical therapy have resulted in a dramatic decline in mortality from acute myocardial infarction (MI) over the last four decades, MI remains the most common cause of in-hospital death in industrialized nations.The approach to managing patients with acute coronary syndromes has evolved dramatically over the past decade and, in many respects, represents a rapidly moving target in light of recent advances in pharmacotherapy and catheter-based revascularization. A number of recently-published studies, including the TACTICS Trial[1], the ADMIRAL Trial[2], and the TARGET Trial[3], provide novel information about the relative merits of pharmacologic therapy and invasive intervention, A common theme from these studies is that there is a growing consensus among cardiologists thatcombinationtherapy with these two modalities may actually provide the best clinical outcomes in ACS patients.

ISSN:0268-4705    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Acute coronary syndromes (ACS), including those associated with or without ST-segment elevation, share a common pathophysiology mediated by activated platelets and thrombin. It is becoming increasingly appreciated that reperfusion therapies using primary mechanical or pharmacologic strategies result in suboptimal reperfusion at the myocardial tissue level. Complete reperfusion of the coronary microvasculature has recently been shown to be an important predictor for survival following myocardial infarction. Abciximab has well-established clinical benefits in numerous interventional trials. Through its anti-platelet and anti-thrombotic activities, abciximab reduces thrombus formation and hence minimizes risk of thrombotic microvascular embolization and improves tissue-level reperfusion. Several recent landmark trials have evaluated the clinical efficacy of adjunctive abciximab during mechanical or pharmacologic reperfusion therapy in the setting of ACS. This article provides an update of the role of abciximab in the treatment for ACS based on the results of these clinical trials.

ISSN:0268-4705    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Optimized medical treatment for the non-ST segment elevation acute coronary syndromes (NSTE ACS) should consist of a combined antithrombotic/anti-anginal regimen. Standard antithrombotic treatment is currently unfractionated heparin and aspirin, and in high-risk patients glycoprotein IIb/IIIa inhibitors. However, low-molecular-weight heparins (LMWHs) have practical and clinical advantages over UFH and can be considered an effective alternative in the medical treatment of ACS and in patients proceeding to surgical interventions. Benefits include a more predictable and stable therapeutic response, no need for coagulation monitoring and a reduced incidence heparin-induced thrombocytopenia. In this context, the LMWH enoxaparin has demonstrated sustained clinical and economic benefits compared with UFH, with no increase in major bleeding complications. In addition, recently published studies indicate that LMWHs can improve reperfusion of the arteries and reduce reocclusion when used as adjunctive anticoagulant therapy in patients with ST segment elevation (STE) ACS undergoing thrombolysis with fibrin-specific agents or streptokinase.

ISSN:0268-4705    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Three-hydroxy-3methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) reduce coronary events and death in both primary and secondary prevention trials. In these trials benefit did not appear for years after randomization[1••,2,3]. It is noteworthy that these trials did not include patients with recent myocardial infarctions or unstable angina. It is well known that mortality and recurrent ischemic events rates are the highest in the early period after acute coronary syndromes[4,5,6]. Favorable physiologic effects of statins have been described within a few weeks of exposure to the statin in a number of experimental studies[7–10]. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study[11]was designed to bridge the gap between primary and secondary prevention trials and specifically included patients with unstable angina or non-ST elevation myocardial infarction.

ISSN:0268-4705    

出版商:OVID    

年代:2001

数据来源: OVID