The first edition of this text was published in 2003 when acute coronary syndrome had become a well-defined clinical entity decades after clinical observations on premonitory symptoms preceding myocardial infarction and sudden death. The syndrome demarcates the acute unstable life-threatening manifestations of coronary atherosclerosis from the silent/stable manifestations of the disease. The bridge between the two conditions is the unstable plaque; diagnostic clues to the presence of such plaques are progressive angina, ST-T changes, and cardiac troponin elevation, all indicators of evolving ischemia. The opportunity to recognize patients at risk and prevent myocardial infarction and cardiac death set the stage for a wealth of fundamental and clinical research on the epidemiology and pathophysiology of dynamic atherosclerosis. It set a model for testing interventions aimed at preventing progression of the disease taking profit from the art of clinical trials being in full expansion. The sample size and event rates were there. Patients with chest pain and acute coronary syndromes indeed populated emergency departments and coronary care units, carrying a high-risk of acute ischemic events and recurrence of an event in the following months. Accordingly, the first edition of this text was mainly didactic and focused on prevalence, pathophysiology, diagnostic methods, and medical management and interventional procedures. It also included coverage of subgroups, secondary prevention, and guidelines recommendations for management.
The second edition of this companion text on Acute Coronary Syndromes, shares the same objective. New materials added include:
- observations from recent large prospective registries,
- data obtained using new antithrombotic and antiplatelet drugs,
- the expanding use of invasive management worldwide in part by creation of transfer networks,
- recent guidelines recommendations, and
- the coronary care unit on the move.
Other trends include:
- an increasing number of innovative drugs,
- an international collaboration for testing intervention safety and efficacy, and
- wide online access to information, educational material and results of clinical trials, all promoting universal standards in the quality of care.
To a certain extent, the progress in basic science conducted in parallel and apparent chaos with innovations converges in a regression to the more fundamental mechanisms and laws of nature. Thus, advances in genetics, pharmacology, hematology, immunology, and technology are all integrated throughout this text.
Acute Coronary Syndromes is aimed at physicians, trainees, and scientists with an interest in general cardiology and atherosclerosis. The format and content of this edition are different from the previous one. Clinically relevant content has been reinforced and more recent and thought-provoking material added. The new chapters shed new light on the present and into the near future.
The second edition consists of five sections with different perspectives. The first is a population-based vision of atherosclerosis and acute coronary syndromes. Epidemiological and clinical data recently acquired from large prospective international, European, and American registries are presented. Most importantly, the risk factor profiles that precede the first myocardial infarction in different parts of the world are described as well as the recently observed shifts in risk factors, disease presentation, treatment and prognosis, and on treatment gaps that are still present. A disease-based perspective is found in Section II. It starts with two updated classic topics and moves to less understood pathophysiologies, and ends with pharmacogenomics, a must in new medicine.
Section III is a patient-based perspective reviewing the available diagnostic tools in acute coronary syndromes. The section starts with clinical recognition and moves to discuss biomarkers, a topic particularly relevant in the context of the new universal definition of myocardial infarction and the emergence of high-sensitivity troponin assays. Specific diagnostic technologies are then discussed; echocardiography, computed tomography, nuclear and magnetic resonance imaging, and more experimental techniques attempting to identify culprit coronary lesions. The various pieces for risk stratification are then put together to the benefit of clinicians.
Section IV is all about therapy, starting with a review of basic medical management with anti-platelet and anticoagulant therapy, anti-ischemic therapy, and a view on new emerging drugs. Important specific issues are then considered including plaque passivation, drug resistance, bleeding, antithrombotic therapy in percutaneous coronary interventions, and disabling angina not amenable to revascularization procedures. Lifestyle interventions with diet and exercise in secondary prevention are also discussed.
The last section is a structure-based perspective. As knowledge grows exponentially, the capability for clinical translation most often lags years behind resulting in important treatment gaps. On the other hand, a sound validation of new data is required before their large-scale application. The first chapter of this section is a thoughtful review of the evolving structures of coronary care units, current needs, and best utilization of available resources. The last chapters highlight the essentials of the most recent ACC/AHA and ESC guidelines recommendations written by the chairs of respective working groups. These organizations have realized the need to be proactive with the medical community to provide the best evidence-based medicine in a timely fashion to optimize rapid clinical translation. Thus, the working groups regularly evaluate the need for an update based on new data that are emerging, breaking the inertia usually found in such approach. A similar response is expected from the clinical community.It is my hope you will enjoy the new edition of this text and that it will enrich your clinical practice and benefit for your patients.
Pierre Théroux, MD
Foreword
At the beginning of the 20th century, coronary artery disease was considered to be a serious condition but the distinction between its two principal presentations, angina pectoris and acute myocardial infarction, was not clear. By the 1920s, the separate clinical and pathological manifestation of chronic angina pectoris and acute myocardial infarction had been established and their differences recognized. In the 1930s a condition characterized by prolonged chest pain that sometimes led to acute myocardial infarction was described, and by the 1940s a syndrome intermediate between angina pectoris and acute myocardial infarction, the so-called “intermediate syndrome” was deemed to be quite common. In the early 1970s, the term unstable angina was coined and we now consider this designation to include patients with the new onset of severe angina, patients with accelerated angina, and those with angina at rest but without evidence of myocardial necrosis.
As unstable angina became more clearly defined, increasing attention was directed to the separation of patients with acute myocardial infarction into those who presented with and those without electrocardiographic ST segment elevation. It then became apparent that patients with unstable angina actually had or frequently developed the latter condition, that is, non−ST segment elevation myocardial infarction (NSTEMI).
By the 1990s, with the development of more sensitive biochemical markers of myocardial necrosis, the distinction between unstable angina and NSTEMI again became blurred. Indeed, an increasing percentage of patients with the former condition were shown actually to have the latter. By the end of the 20th century, it became clear that from both pathophysiologic and clinical points of view that these two conditions should be considered together and they are now commonly referred to as non−ST segment elevation acute coronary syndromes (NSTE-ACS).
Research on acute coronary syndromes has exploded on many fronts and this impressive second edition of Acute Coronary Syndromes, edited by Pierre Théroux, masterfully captures the major developments. It carefully explores the many epidemiologic, clinical, pathophysiologic, and therapeutic advances in the field.
The enormous frequency of this condition and its seriousness places it at “the heart” of cardiology. Indeed, just about every adult cardiologist—whether an invasive or a non-invasive cardiologist, whether primarily office- or hospital-based, whether specializing in hypertension, heart failure, prevention, or rehabilitation—encounters patients with acute coronary syndromes and must be comfortable with their diagnosis and management.
Cardiologists dealing with these patients will be indebted to Dr. Théroux, an experienced clinician and investigator in this field, and his talented authors for providing this important new book. We are proud that it is a companion to Braunwald's Heart Disease—A Textbook of Cardiovascular Medicine.
Eugene Braunwald, Robert O. Bonow, Peter Libby, Douglas L. Mann, Douglas P. Zipes
Key Features
- Tap into the most definitive knowledge available from one of the leading experts in the field and a stellar cast of contributors.
- Understand the special considerations for the care of acute coronary syndromes in the emergency department and the coronary care unit.
- Effectively handle the treatment of special populations and chronic patients thanks to coverage of these challenges.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
New to this edition
- Access the fully searchable contents of the book online at expertconsult.com.
- See techniques and procedures in greater detail and clarity through the all-new full-color design.
- Approach treatment with a global perspective from the new section on Population-Based Perspective that discusses the INTERHEART study, insights from the REACH registry, lessons learned from European registries, and ACS in North America.
- Gain a comprehensive understanding of ACS through coverage of pathophysiology, molecular mechanisms, the role of the immune system, and brand-new chapters on cell necrosis and cell regeneration and pharmacogenetics in the section on Disease-Based Perspectives.
Contents
Section I - A Population-Based Perspectives
- CHAPTER 1 - The Past, the Present, the Future
- CHAPTER 2 - Risk Factors Predicting Nonfatal Myocardial Infarction: The INTERHEART Study
- CHAPTER 3 - Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry
- CHAPTER 4 - Historical Perspective and Lessons Learned from the Euro Heart Surveys on Acute Coronary Syndromes
- CHAPTER 5 - Acute Coronary Syndrome in North America
Section II - Disease-Based Perspectives
- CHAPTER 6 - Pathogenesis of Stable and Acute Coronary Syndromes
- CHAPTER 7 - Molecular Mechanisms of the Acute Coronary Syndromes: The Roles of Inflammation and Immunity
- CHAPTER 8 - The Immune System in Acute Coronary Syndrome
- CHAPTER 9 - Myocardial Cell Death and Regeneration
- CHAPTER 10 - Pharmacogenomics
Section III - Patient-Based Perspectives, Diagnosis, and Risk Stratification
- CHAPTER 11 - Clinical Recognition of Acute Coronary Syndromes
- CHAPTER 12 - Biomarkers in Acute Ischemic Heart Disease
- CHAPTER 13 - Prognostic Risk Stratification After Acute Coronary Syndromes: The Role of Noninvasive Testing
- CHAPTER 14 - Echocardiography in Acute Coronary Syndromes
- CHAPTER 15 - Nuclear Cardiology Techniques in Acute Coronary Syndromes
- CHAPTER 16 - Multislice Computed Tomography in Acute Coronary Syndromes
- Chapter 17 - Emerging Diagnostic Procedures for the Vulnerable Plaque
- CHAPTER 18 - Risk Stratification in Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
Section IV - Management of Acute Coronary Syndromes
- CHAPTER 19 - Treatment Principles and Emerging Therapies in Acute Coronary Syndromes without ST-Segment Elevation
- CHAPTER 20 - Antiplatelet Therapy
- CHAPTER 21 - Nonresponsiveness to Antiplatelet Therapy
- CHAPTER 22 - Anticoagulants
- CHAPTER 23 - Beta Blockers, Calcium Channel Blockers, Ranolazine, Nitrates, and Nitric Oxide Donors: Use in Acute Coronary Syndromes
- CHAPTER 24 - Adenosine Triphosphate–Sensitive Potassium Channels, Adenosine, and Preconditioning
- CHAPTER 25 - Inflammation and Immunity as Targets for Drug Therapy in Acute Coronary Syndrome
- CHAPTER 26 - Plaque Passivation and Endothelial Therapy
- CHAPTER 27 - Revascularization in Non–ST-Segment Elevation Acute Coronary Syndrome—For Whom, When, and How?
- CHAPTER 28 - Percutaneous Coronary Intervention and Concomitant Antithrombotic Therapy
- CHAPTER 29 - Bleeding in the Acute Coronary Syndromes
- CHAPTER 30 - The Patient with Disabling [Refractory] Angina Not Amenable to Revascularization Procedures
- CHAPTER 31 - Dietary Intervention in Coronary Care Units and in Secondary Prevention
- CHAPTER 32 - Exercise Training After an Acute Coronary Syndrome
Section V - A Structure-Based Perspective of the Modern CCU and Treatment Guidelines
- CHAPTER 33 - Diagnosis and Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes: European Society of Cardiology Guidelines
- CHAPTER 34 - ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non–ST-Segment Elevation Myocardial Infarction—A Summary Article
- CHAPTER 35 - The Modern Cardiac Care Unit
Product Details
- Hardcover: 448 pages
- Publisher: Saunders; 2 edition (September 24, 2010)
- Language: English
- ISBN-10: 1416049274
- ISBN-13: 978-1416049272
- Product Dimensions: 10.7 x 8.8 x 0.9 inches
Look for These Other Titles in the Braunwald's Heart Disease Companions Series
- Acute Coronary Syndromes by Pierre Theroux
- Atlas of Cardiac Computed Tomography by Allen J. Taylor
- Atlas of Cardiovascular Magnetic Resonance Imaging by Christopher M. Kramer and W. Greg Hundley
- Clinical Lipidology by Christie M. Ballantyne
- Clinical Arrhythmology and Electrophysiology by Ziad Issa, John M. Miller and Douglas P. Zipes
- Heart Failure by Douglas L. Mann
- Preventive Cardiology by Roger S. Blumenthal, Joanne M. Foody and Nathan D. Wong