scholarly journals An Invasive or Conservative Strategy in Patients With Diabetes Mellitus and Non–ST-Segment Elevation Acute Coronary Syndromes

2012 ◽  
Vol 60 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Michelle L. O'Donoghue ◽  
Ajay Vaidya ◽  
Rizwan Afsal ◽  
Joakim Alfredsson ◽  
William E. Boden ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndromes ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Patients With Diabetes ◽  
Coronary Syndromes

scholarly journals Diabetes mellitus and acute coronary syndromes

2021 ◽  
Vol 17 (4) ◽  
pp. 346-360
Author(s):  
V.A. Serhiyenko ◽  
A.A. Serhiyenko
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Assessment Tools ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Patients With Diabetes ◽  
Coronary Syndromes

This review article summarizes the existing literature on the current state of the problem of diabetes mellitus and acute coronary syndromes. In particular, the issues are analyzed related to the etiology, epidemiology, main pathophysiological features, classification of acute coronary syndromes, acute coronary syndromes without persistent ST-segment elevation on the electrocardiogram, acute coronary syndromes with ST-segment elevation, non-athe­rosclerotic causes of acute coronary syndrome, laboratory and instrumental diagnostic tests. Issues were analyzed related to the main approaches to the treatment of acute coronary syndromes, management of patients with diabetes mellitus and acute coronary syndromes, recommendations for secondary prevention. Initial treatment with corticosteroids includes acetylsalicylic acid, bolus heparin and intravenous heparin infusion (in the absence of contraindications). Antiplatelet therapy with ticagrelor or clopidogrel is also recommended. Pain is controlled using morphine/fentanyl and oxygen in case of hypoxia. Nitroglycerin can also be used sublingually or by infusion to relieve pain. Continuous monitoring of myocardial activity for arrhythmia is required. The choice of reperfusion strategy in patients with diabetes mellitus should be based on many factors, including assessment of clinical status (hemodynamic/electrical instability, prolonged ischemia), complications of chronic coronary syndrome, ischemic load, echocardiography, assessment of left ventricular function and any other comorbidities. In addition, various methods for assessing coronary artery disease and predicting mortality due to surgery are needed to make a final decision. 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 the invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with acute coronary syndrome.

scholarly journals Conservative strategy in patients with non-ST-segment elevation acute coronary syndromes

2010 ◽  
Vol 4 ◽  
pp. 147-153
Author(s):  
Jarosław Zalewski ◽  
Krzysztof Nycz ◽  
Tadeusz Przewłocki ◽  
Marek Andres ◽  
Monika Durak ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes

scholarly journals Characterizing Young Patients With Diabetes and Non-ST-Segment Elevation Acute Coronary Syndromes

Diabetes Care ◽  
2007 ◽  
Vol 30 (3) ◽  
pp. 731-733 ◽  
Author(s):  
R. H. Mehta ◽  
S. Milford-Beland ◽  
E. D. Peterson ◽  
D. L. Bhatt ◽  
M. E. Farkouh ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Young Patients ◽  
St Segment Elevation ◽  
St Segment ◽  
Patients With Diabetes ◽  
Coronary Syndromes

Parenteral anticoagulation in non-ST segment elevation acute coronary syndromes: which option to pick?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Sousa ◽  
P Lopes ◽  
P Azevedo ◽  
R Baptista ◽  
C Gavina ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndromes ◽  
Primary Efficacy ◽  
Efficacy And Safety ◽  
Major Hemorrhage ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes

Abstract Background According to the 2015 European Society of Cardiology's non-ST segment elevation acute coronary syndrome (NSTE-ACS) clinical practice guideline, fondaparinux is the parenteral anticoagulant with the most favorable efficacy/safety profile. Thus, it is recommended over enoxaparin, for instance, in that setting. However, its use and performance in a contemporary portuguese cohort has not been fully described. Purpose To assess fondaparinux utilization degree and to compare its in-hospital efficacy and safety profiles with those of enoxaparin, in a contemporary portuguese cohort of NSTE-ACS patients. Methods Patients consecutively admitted with NSTE-ACS, between October 2010 and January 2019, were retrospectively identified from a national registry of acute coronary syndromes and were further divided in two groups, as per parenteral anticoagulation strategy (fondaparinux vs. enoxaparin). Key exclusion criteria were specific contraindications to both agents, recent hemorrhagic stroke and indications for anticoagulation other than ACS. The primary efficacy endpoint was a composite of in-hospital reinfarction and mortality, whereas the primary safety endpoint was moderate-to-severe bleeding, as defined by the GUSTO criteria. Results A total of 5843 NSTE-ACS patients (mean age 65±13 years, 72.4% males) were included. Of these, 89.2% had a myocardial infarction, while the remaining 10.8% were diagnosed with unstable angina. The most frequent cardiovascular comorbidities were hypertension (71.3%), dyslipidemia (63.0%) and diabetes mellitus (31.7%). Fondaparinux was the anticoagulant of choice in 27.5% of patients, whereas the remainder were treated with enoxaparin. Compared with patients receiving enoxaparin, those in the fondaparinux group were younger, had less hypertension or diabetes mellitus and exhibited a less severe presentation; nonetheless, they had more often a previous history of coronary artery disease or hemorrhagic events. An invasive approach in terms of revascularization was adopted in 87.7% of the cohort (79.1% in the fondaparinux group vs. 90.9% in the enoxaparin group, p<0.001). The primary efficacy and safety endpoints occurred in 2.4% and 4.7% of patients, respectively. After adjustment for relevant covariates, the use of fondaparinux was independently associated with a lower rate of both the primary efficacy (OR 0.56 [0.32–0.95], p=0.034) and the primary safety endpoints (OR 0.37 [0.23–0.59], p<0.001). Conclusion In a contemporary portuguese cohort of NSTE-ACS patients, fondaparinux was underused but still independently associated with a lower risk of both a composite of in-hospital reinfarction or mortality event and major hemorrhage. Funding Acknowledgement Type of funding source: None

scholarly journals Non-ST Segment Elevation Acute Coronary Syndromes and High-Sensitivity Cardiac Troponin T: Is this the end of the Conservative Strategy?

2018 ◽  
Vol 86 (5) ◽  
pp. 336-341
Author(s):  
Víctor Mauro ◽  
Alessis Rafaelli ◽  
Yanina B. Castillo Costa ◽  
Adrián Charask ◽  
Enrique Fairman ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes
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