title: Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2.
abstract: Acute coronary syndrome (ACS) remains a major burden on morbidity and mortality in the United States. Medical professionals and students often use the mnemonic 'MONA' (morphine, oxygen, nitroglycerin and aspirin) to recall treatments for ACS; however, this list of therapies is outdated. We provide a historical perspective on 'MONA,' attempt to uncover its origin in the medical literature, and demonstrate the myriad changes that have occurred over the last 50 years of ACS management. We have developed a novel mnemonic, 'THROMBINS2' (thienopyridines, heparin/enoxaparin, renin-angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate) to help bedside clinicians recall all the elements of contemporary ACS management. We demonstrate the mortality benefit for each component of contemporary ACS management, correlating the continued improvement with historical data on mortality after myocardial infarction. We encourage providers to utilize this mnemonic to explore options and guide treatments in ACS patients.
authors.affiliation: a 1 Department of Internal Medicine, University of Florida , Gainesville, FL, USA.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Kline
authors.affiliation: b 2 Division of Cardiovascular Medicine, University of Florida , Gainesville, FL, USA.
authors.forename: C Richard
authors.initials: CR
authors.lastname: Conti
authors.affiliation: b 2 Division of Cardiovascular Medicine, University of Florida , Gainesville, FL, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
mesh_terms: D054058:Acute Coronary Syndrome / Q000145:classification / Q000188:drug therapy / Q000266:history*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D019468:Disease Management; D006493:Heparin / Q000627:therapeutic use; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D058924:Thienopyridines / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D058924:Thienopyridines; D009020:Morphine; D006493:Heparin; D005996:Nitroglycerin; D001241:Aspirin
keywords: Acute myocardial infarction; ST-elevation myocardial infarction; acute coronary syndrome; coronary artery disease; non-ST-elevation myocardial infarction; unstable angina