{"id":696,"date":"2023-10-26T11:26:30","date_gmt":"2023-10-26T15:26:30","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/rxpidresources\/chapter\/acute-coronary-syndrome\/"},"modified":"2023-11-10T16:39:18","modified_gmt":"2023-11-10T21:39:18","slug":"acute-coronary-syndrome","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/rxpidresources\/chapter\/acute-coronary-syndrome\/","title":{"raw":"Acute Coronary Syndrome","rendered":"Acute Coronary Syndrome"},"content":{"raw":"
\r\n
In this chapter,\u00a0you will find Canadian guidelines for the acute management of patients presenting with a STEMI\/NSTEMI and recommended drug therapy long term. The majority of resources provided are related to dual antiplatelet therapy and optimal duration of therapy for specific patients.<\/div>\r\n<\/div>\r\n

Student Resources<\/h2>\r\nAcute Coronary Syndrome One Pager<\/a>\r\n\r\nCAD Drug Tables<\/a>\r\n

Tools<\/h1>\r\n
DAPT Score<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess risk of thromboembolic events to determine if patients would benefit from extended DAPT.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nTool consists of risk factors associated with increased risk of thromboembolic events.\r\n\r\nInterpretation of results:\r\n
    \r\n \t
  • -2 to 1: extended DAPT not recommended<\/li>\r\n \t
  • 2+: Extended DAPT recommended<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nIn all patients with a PCI who have received DAPT for 1 year, we recommend using this scoring tool to determine if patients should discontinue DAPT and continue on single anti platelet therapy or extend DAPT for up to 3 years.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
Thrombolysis in Myocardial Infarction Score (TIMI)<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess patients risk of mortality, recurrent MI or ischemia in the next 14 days in patients with unstable angina or NSTEMI [pb_glossary id=\"55\"]unstable angina[\/pb_glossary].<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nTool consists of risk factors associated with mortality.\r\n\r\nInterpretation of results:\r\n
    \r\n \t
  • 0 to 1: 5%<\/li>\r\n \t
  • 2: 8%<\/li>\r\n \t
  • 3: 13%<\/li>\r\n \t
  • 4: 20%<\/li>\r\n \t
  • 5: 26%<\/li>\r\n \t
  • 6-7: 41%<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nIn patients with unstable angina or an NSTEMI, use this scoring tool to determine your patients risk of mortality or recurrent cardiovascular event.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a>\r\n<\/strong><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>\r\n

Guidelines<\/h1>\r\n
The Canadian Cardiovascular Society Guidelines<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nGuide treatment recommendations for patients presenting with acute STEMI.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nGuideline<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\n\r\n
    \r\n \t
  1. PCI vs fibrinolytic considerations<\/li>\r\n \t
  2. Drug therapy recommendations in acute setting<\/li>\r\n<\/ol>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nThese detailed guidelines are a great source of information to review acute treatment management in patients with a myocardial infarction.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
The Canadian Cardiovascular Society \u2192 Duration of DAPT<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nGuide treatment recommendations for duration of DAPT in patients who undergo PCI.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nGuideline<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\n\r\n
    \r\n \t
  1. Duration of DAPT therapy based on individual characteristics<\/li>\r\n \t
  2. Clinical features which place patients at high risk of thromboembolic events (extended DAPT recommended)<\/li>\r\n \t
  3. Factors associated with increased bleeding risk (shorted DAPT recommended)<\/li>\r\n \t
  4. Practical tips for the clinical setting<\/li>\r\n<\/ol>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nIn all patients with a PCI, this is a great tool to assess the optimal duration of DAPT therapy in your individual patient.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE (full guidelines)<\/a> - VIEW RESOURCE (pocket guidelines)<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
Post MI Care<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nGuide treatment recommendations for long term management in patients post-MI.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nSummary of trials and recommended drug therapy post MI<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\n\r\n
    \r\n \t
  1. Indications for drug therapy<\/li>\r\n \t
  2. Recommended dosages<\/li>\r\n \t
  3. Contraindications for drug therapy<\/li>\r\n \t
  4. Benefits patients may receive from the drug therapy<\/li>\r\n<\/ol>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nA great tool with a summary of drug therapy recommended for patients with a history of MI.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>","rendered":"
\n
In this chapter,\u00a0you will find Canadian guidelines for the acute management of patients presenting with a STEMI\/NSTEMI and recommended drug therapy long term. The majority of resources provided are related to dual antiplatelet therapy and optimal duration of therapy for specific patients.<\/div>\n<\/div>\n

Student Resources<\/h2>\n

Acute Coronary Syndrome One Pager<\/a><\/p>\n

CAD Drug Tables<\/a><\/p>\n

Tools<\/h1>\n
\nDAPT Score<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess risk of thromboembolic events to determine if patients would benefit from extended DAPT.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nTool consists of risk factors associated with increased risk of thromboembolic events.<\/p>\n

Interpretation of results:<\/p>\n

    \n
  • -2 to 1: extended DAPT not recommended<\/li>\n
  • 2+: Extended DAPT recommended<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nIn all patients with a PCI who have received DAPT for 1 year, we recommend using this scoring tool to determine if patients should discontinue DAPT and continue on single anti platelet therapy or extend DAPT for up to 3 years.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nThrombolysis in Myocardial Infarction Score (TIMI)<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess patients risk of mortality, recurrent MI or ischemia in the next 14 days in patients with unstable angina or NSTEMI unstable angina.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nTool consists of risk factors associated with mortality.<\/p>\n

Interpretation of results:<\/p>\n

    \n
  • 0 to 1: 5%<\/li>\n
  • 2: 8%<\/li>\n
  • 3: 13%<\/li>\n
  • 4: 20%<\/li>\n
  • 5: 26%<\/li>\n
  • 6-7: 41%<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nIn patients with unstable angina or an NSTEMI, use this scoring tool to determine your patients risk of mortality or recurrent cardiovascular event.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a>
\n<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n

Guidelines<\/h1>\n
\nThe Canadian Cardiovascular Society Guidelines<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nGuide treatment recommendations for patients presenting with acute STEMI.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nGuideline<\/td>\n<\/tr>\n
Included<\/strong><\/td>\n\n
    \n
  1. PCI vs fibrinolytic considerations<\/li>\n
  2. Drug therapy recommendations in acute setting<\/li>\n<\/ol>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nThese detailed guidelines are a great source of information to review acute treatment management in patients with a myocardial infarction.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nThe Canadian Cardiovascular Society \u2192 Duration of DAPT<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nGuide treatment recommendations for duration of DAPT in patients who undergo PCI.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nGuideline<\/td>\n<\/tr>\n
Included<\/strong><\/td>\n\n
    \n
  1. Duration of DAPT therapy based on individual characteristics<\/li>\n
  2. Clinical features which place patients at high risk of thromboembolic events (extended DAPT recommended)<\/li>\n
  3. Factors associated with increased bleeding risk (shorted DAPT recommended)<\/li>\n
  4. Practical tips for the clinical setting<\/li>\n<\/ol>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nIn all patients with a PCI, this is a great tool to assess the optimal duration of DAPT therapy in your individual patient.<\/td>\n<\/tr>\n
VIEW RESOURCE (full guidelines)<\/a> – VIEW RESOURCE (pocket guidelines)<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nPost MI Care<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nGuide treatment recommendations for long term management in patients post-MI.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nSummary of trials and recommended drug therapy post MI<\/td>\n<\/tr>\n
Included<\/strong><\/td>\n\n
    \n
  1. Indications for drug therapy<\/li>\n
  2. Recommended dosages<\/li>\n
  3. Contraindications for drug therapy<\/li>\n
  4. Benefits patients may receive from the drug therapy<\/li>\n<\/ol>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nA great tool with a summary of drug therapy recommended for patients with a history of MI.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
definition<\/span>