Plaque Passivation and Endothelial Therapy
The central role of the unstable plaque and disturbed endothelial function in acute coronary syndromes is described in Chapters 6 and 17 . This chapter briefly reviews these mechanisms and…
Inflammation and Immunity as Targets for Drug Therapy in Acute Coronary Syndrome
Inflammation has been associated with myocardial infarction, even before the recognition that acute coronary thrombi cause coronary occlusion and a time-dependent loss of myocardial muscle. In response to injury, the…
Anticoagulants
The Role of Thrombosis in Ischemic Heart Disease Although acute coronary syndromes are divided for the purpose of treatment assignment into unstable angina, non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment…
Emerging Diagnostic Procedures for the Vulnerable Plaque
Coronary atherosclerotic disease is the leading cause of morbidity and mortality in the Western world. Atherosclerosis is a multifocal process generally confined to the intima of the coronary arteries. Despite…
Beta Blockers, Calcium Channel Blockers, Ranolazine, Nitrates, and Nitric Oxide Donors: Use in Acute Coronary Syndromes
The current focus of the management of the acute coronary syndromes (ACS) is on antithrombotic and antiplatelet agents and the selection and timing of revascularization procedures. With a few notable…
Adenosine Triphosphate–Sensitive Potassium Channels, Adenosine, and Preconditioning
Ischemic preconditioning refers to the ability of short periods of ischemia to make the myocardium more resistant to a subsequent ischemic insult. This term was introduced for the first time…
Nonresponsiveness to Antiplatelet Therapy
Platelets play a pivotal role in mediating thrombotic complications of atherosclerotic vascular disease. Oral antiplatelet agents are the cornerstone of pharmacologic therapy for preventing ischemic events of atherothrombotic disease. Aspirin…
Antiplatelet Therapy
The management of patients with acute coronary syndrome (ACS), whether in the initial or later stages of disease, is rooted firmly in three fundamental pathobiological constructs—atherosclerosis, thrombosis, and vascular repair….
Risk Stratification in Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
Unstable angina (UA) is classically defined as ischemic discomfort that occurs at rest (or with minimal exertion), occurs with a crescendo pattern, or is severe and of new onset. If…
Treatment Principles and Emerging Therapies in Acute Coronary Syndromes without ST-Segment Elevation
Atherosclerosis is a multifactorial disease presenting with diverse clinical phenotypes. For example, manifestations range from an elderly patient with few or no symptoms and three-vessel disease, to an asymptomatic individual…
