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Diagnosis and management of non-STEMI coronary syndromes 

Diagnosis and management of non-STEMI coronary syndromes
Chapter:
Diagnosis and management of non-STEMI coronary syndromes
Author(s):

David Erlinge

and Göran Olivecrona

DOI:
10.1093/med/9780199600830.003.0146
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date: 20 February 2020

Acute coronary syndromes are classified as ST segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or unstable angina. Most patients with NSTEMI present with a history of chest pain that has subsided spontaneously before or soon after arrival at the emergency room, but with positive cardiac markers (usually troponin T or I) indicative of myocardial infarction. NSTEMI has a risk of recurrent myocardial infarction of 15–20% and a 15% chance of 1-year mortality. Patients with non-STE-acute coronary syndromes are at similar risk as a STEMI patient at 1 year. The strongest objective signs of NSTEMI are a positive troponin and ST segment depression. NSTEMI should be acutely treated with aspirin, an adenosine diphosphate-receptor antagonist, and an anticoagulant (fondaparinux or low molecular weight heparins). NSTEMI should be investigated with coronary angiography within 72 hours. Curative treatment is percutaneous coronary intervention or coronary artery bypass grafting.

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