title: Acute coronary syndromes.
abstract: In the UK, there are over 80,000 admissions annually with acute coronary syndromes (ACS). Management of ST-elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PCI), which is delivered via dedicated heart attack centres. Non-ST elevation-ACS (NSTE-ACS) accounts for two-thirds of ACS presentations, affecting an older cohort of patients - often with more complex comorbidities. Initial management is with anti-thrombotic therapy with a view to PCI within 24 hours for the most acute cases and within 72 hours for all others. However, varying management pathways and access to specialist cardiology services results in variable times to definitive treatment. Advances in the sensitivity of cardiac biomarkers and the use of risk assessment tools now enable rapid diagnosis within a few hours of symptom onset. Advances in invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with ACS.
authors.affiliation: Royal Free Hospital and UCL Institute of Cardiovascular Science, London, UK.
authors.forename: Tushar
authors.initials: T
authors.lastname: Kotecha
authors.affiliation: Royal Free Hospital and UCL Institute of Cardiovascular Science, London, UK.
authors.forename: Roby D
authors.initials: RD
authors.lastname: Rakhit
mesh_terms: D054058:Acute Coronary Syndrome; D019468:Disease Management; D004562:Electrocardiography; D005260:Female; D006401:Hematologic Agents; D006801:Humans; D008297:Male; D009203:Myocardial Infarction
chemical_list: D006401:Hematologic Agents
keywords: Acute coronary syndrome; ST-elevation myocardial infarction; non-ST elevation acute coronary syndrome; non-ST elevation ­myocardial infarction