The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes

A Primer for the Internist

R. Jay Widmer, Peter M. Pollak, Malcolm R. Bell, Bernard J. Gersh, Nandan S. Anavekar

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes. With an ever-growing body and weight of knowledge in this field, the clinician is tasked with several challenges. First, there are a variety of pathways of care to be considered; second, adjunctive medical therapies are expanding; and third, when coupled with the multiple combinations of adjunctive supportive therapies for revascularization, the variety of potential therapeutic options can be overwhelming and confusing. Herein, we carefully review all the relevant guidelines and the contributing literature, taking a 4-step approach: (1) review the importance of risk stratification before engaging in a particular strategy of care, (2) define the reperfusion strategies available, (3) review the specific agents (antiplatelet and anticoagulant) that support reperfusion strategies, and (4) apply the strategies of care in the context of the clinical presentation.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Myocardial Reperfusion
Acute Coronary Syndrome
Reperfusion
Guidelines
Platelet Aggregation Inhibitors
Anticoagulants
Therapeutics
Body Weight

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes : A Primer for the Internist. / Widmer, R. Jay; Pollak, Peter M.; Bell, Malcolm R.; Gersh, Bernard J.; Anavekar, Nandan S.

In: Mayo Clinic Proceedings, 01.01.2018.

Research output: Contribution to journalArticle

Widmer, R. Jay ; Pollak, Peter M. ; Bell, Malcolm R. ; Gersh, Bernard J. ; Anavekar, Nandan S. / The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes : A Primer for the Internist. In: Mayo Clinic Proceedings. 2018.
@article{8c9598b95248495381c714e66703d0a8,
title = "The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes: A Primer for the Internist",
abstract = "Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes. With an ever-growing body and weight of knowledge in this field, the clinician is tasked with several challenges. First, there are a variety of pathways of care to be considered; second, adjunctive medical therapies are expanding; and third, when coupled with the multiple combinations of adjunctive supportive therapies for revascularization, the variety of potential therapeutic options can be overwhelming and confusing. Herein, we carefully review all the relevant guidelines and the contributing literature, taking a 4-step approach: (1) review the importance of risk stratification before engaging in a particular strategy of care, (2) define the reperfusion strategies available, (3) review the specific agents (antiplatelet and anticoagulant) that support reperfusion strategies, and (4) apply the strategies of care in the context of the clinical presentation.",
author = "Widmer, {R. Jay} and Pollak, {Peter M.} and Bell, {Malcolm R.} and Gersh, {Bernard J.} and Anavekar, {Nandan S.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.mayocp.2017.11.016",
language = "English (US)",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",

}

TY - JOUR

T1 - The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes

T2 - A Primer for the Internist

AU - Widmer, R. Jay

AU - Pollak, Peter M.

AU - Bell, Malcolm R.

AU - Gersh, Bernard J.

AU - Anavekar, Nandan S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes. With an ever-growing body and weight of knowledge in this field, the clinician is tasked with several challenges. First, there are a variety of pathways of care to be considered; second, adjunctive medical therapies are expanding; and third, when coupled with the multiple combinations of adjunctive supportive therapies for revascularization, the variety of potential therapeutic options can be overwhelming and confusing. Herein, we carefully review all the relevant guidelines and the contributing literature, taking a 4-step approach: (1) review the importance of risk stratification before engaging in a particular strategy of care, (2) define the reperfusion strategies available, (3) review the specific agents (antiplatelet and anticoagulant) that support reperfusion strategies, and (4) apply the strategies of care in the context of the clinical presentation.

AB - Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes. With an ever-growing body and weight of knowledge in this field, the clinician is tasked with several challenges. First, there are a variety of pathways of care to be considered; second, adjunctive medical therapies are expanding; and third, when coupled with the multiple combinations of adjunctive supportive therapies for revascularization, the variety of potential therapeutic options can be overwhelming and confusing. Herein, we carefully review all the relevant guidelines and the contributing literature, taking a 4-step approach: (1) review the importance of risk stratification before engaging in a particular strategy of care, (2) define the reperfusion strategies available, (3) review the specific agents (antiplatelet and anticoagulant) that support reperfusion strategies, and (4) apply the strategies of care in the context of the clinical presentation.

UR - http://www.scopus.com/inward/record.url?scp=85040130259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040130259&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2017.11.016

DO - 10.1016/j.mayocp.2017.11.016

M3 - Article

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

ER -