ABSTRACT
Spontaneous coronary artery dissection (SCAD), although in the majority of cases presents as an acute coronary syndrome (ACS), has different pathophysiology from atherosclerosis that influences specific angiography findings and enables most patients to be solved by optimal medical therapy rather than percutaneous coronary intervention (PCI). Therefore, accurate diagnosis is essential for adequate treatment of each patient as management of SCAD differs from that of ACS of atherosclerotic aetiology. So far, invasive coronary angiography remains the most important diagnostic tool in suspected SCAD. However, there are ambiguous cases that can mimic SCAD. In this review, the authors summarize current knowledge about the diagnostic algorithms, particularly angiographic features of SCAD, pitfalls of angiography, and the role of intracoronary imaging in the context of SCAD diagnosis. Finally, apart from the pathognomonic angiographic features of SCAD that are thoroughly discussed in this review, the authors focus on obscure angiography findings and findings that can mimic SCAD as well. Differential diagnosis and the timely recognition of SCAD are crucial as there are differences in the acute and long-term management of SCAD and other causes of ACS.
ABSTRACT
Until a few years ago, the mainstay of anti-platelet therapy in patients with acute coronary syndrome (ACS) was the combination of aspirin and clopidogrel, a P2Y12 receptor inhibitor. However, current clinical practice has now changed with the introduction of ticagrelor, a more potent cardiovascular drug than clopidogrel, without the limitations related to clopidogrel therapy. In this review, we provide a critical overview of ticagrelor in ACS, highlight the results with ticagrelor in several subgroups of patients and discuss the future trials.
Subject(s)
Acute Coronary Syndrome/drug therapy , Adenosine/analogs & derivatives , Platelet Aggregation Inhibitors/therapeutic use , Purinergic P2 Receptor Antagonists/therapeutic use , Acute Coronary Syndrome/physiopathology , Adenosine/administration & dosage , Adenosine/pharmacology , Adenosine/therapeutic use , Aspirin/therapeutic use , Clopidogrel , Double-Blind Method , Female , Humans , Male , Purinergic P2 Receptor Antagonists/administration & dosage , Purinergic P2 Receptor Antagonists/pharmacology , Randomized Controlled Trials as Topic , Risk Assessment , Ticagrelor , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Treatment OutcomeABSTRACT
Although acute ST elevation myocardial infarction (STEMI) was described nearly a century ago, it remains a major health problem not only in the U.S. but also worldwide with more than three million people suffering STEMI every year. Primary percutaneous coronary intervention (PPCI) is now the treatment of choice for the management of patients with STEMI. In the 20th century, fibrinolytics were the agents of choice for the management of patients with acute STEMI and they continue to be utilized in centers where PPCI facilities are not readily available. Large-scale trials were performed comparing streptokinase and new agents such as the recombinant tissue-type plasminogen activators. This article discusses the use of recombinant tissue plasminogen activators for the management of patients with acute STEMI and the importance of restoring optimal timely reperfusion of the myocardium.
