Handbook of Acute Coronary Syndromes

338 Pages·2003·1.22 MB·English

by  Jeroen J. Bax

Acute coronary syndromes (ACS), ranging from ST-segment elevation myocardial infarction to H
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unstable angina, represent a major health care challenge. For busy professionals managing n
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ACS patients, it is difficult to keep up with the myriad changes that are occurring in our b
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understanding and in the treatment of this common, debilitating condition. o
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We have assembled a group of internationally renowned experts to discuss the o
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pathophysiology, risk stratification, and treatment of ACS, with and without ST-segment A
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elevation. This book provides readers with easy access to practical information on the u
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diagnosis and management of patients with ACS. It is an essential resource for the wide range e

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of health care professionals who manage ACS patients. o
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Contents n
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Pathophysiology, classification, and clinical features • Epidemiology • Risk assessment r
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• Antiplatelet agents • Anticoagulants • Fibrinolysis • Long-term prevention • Interventional S
strategies • Mechanical and electrical complications • Guidelines • Future perspectives yn Acute Coronary
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Deepak L Bhatt, MD FACC FSCAI FESC s
Deepak L Bhatt is Director of The Cleveland Clinic Interventional Cardiology Fellowship Syndromes
Program. His research includes the optimal management of ACS, as well as the study of both
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oral and intravenous antithrombotic medications. Dr Bhatt also has research interests in e
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advanced techniques in cardiac, cerebral, and peripheral intervention. He serves as the a
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principal investigator for a number of ongoing trials. He is on the editorial board of Acute L B
Coronary Syndromes and the Journal of Invasive Cardiology. Dr Bhatt is the author of ha Deepak L Bhatt & Marcus D Flather, Editors
numerous research papers, and the editor of Essential Concepts in Cardiovascular Intervention tt &
(Remedica Publishing, 2004). M
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Marcus D Flather, BSc MBBS FRCP s
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Marcus Flather is the Director of the Clinical Trials and Evaluation Unit at the Royal Brompton F
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and Harefield NHS Trust. He is also an Honorary Consultant Cardiologist at the Royal Brompton th
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Hospital and Honorary Senior Lecturer at the Imperial College of Science, Technology and r, E
Medicine. Prior to this, he worked as a Senior Research Fellow at McMaster University in dito
Canada and at the Clinical Trials Service Unit in Oxford. He has been a principal investigator in rs
a number of international studies and his primary research interest is clinical trials in ACS.
Broader interests include clinical trial methods, meta-analysis, and health services research.
497/2004/2
Handbook of
Acute Coronary
Syndromes
Published by Remedica Publishing
32–38 Osnaburgh Street, London, NW1 3ND, UK
Remedica Inc, Civic Opera Building, 20 North Wacker Drive,
Suite 1642, Chicago, IL, 60606, USA
Tel: [phone]
Fax: [phone]
Email: [email protected]
www.remedica.com/books
Publisher: Andrew Ward
In-house editor: Thomas Moberly
Printed in Canada
© 2004 Remedica Publishing
While every effort is made by the publishers and authors to see that no
inaccurate or misleading data, opinions, or statements appear in this book,
they wish to make it clear that the material contained in the publication
represents a summary of the independent evaluations and opinions of the
authors and contributors. As a consequence, the authors, publishers, and any
sponsoring company accept no responsibility for the consequences of any such
inaccurate or misleading data, opinions, or statements. Neither do they endorse
the content of the publication or the use of any drug or device in a way that
lies outside its current licensed application in any territory.
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior
permission of the publisher.
First edition: ISBN 1 901346 65 X
First edition with expanded index 2004
British Library Cataloguing in-Publication Data
A catalogue record for this book is available from the British Library.
Handbook of
Acute Coronary
Syndromes
Deepak L Bhatt & Marcus D Flather, Editors
Editors
Deepak L Bhatt, MD, FACC, FSCAI, FESC
Director, Interventional Cardiovascular Fellowship
Associate Director, Cardiovascular Medicine Fellowship
Staff, Cardiac, Peripheral, and Cerebrovascular Intervention
Cleveland Clinic Foundation
Department of Cardiovascular Medicine
9500 Euclid Avenue, Desk F25
Cleveland, OH 44195
USA
Marcus D Flather, BSc, MBBS, FRCP
Director, Clinical Trials & Evaluation Unit
Royal Brompton Hospital
Sydney Street
London
SW3 6NP
UK
Contributors
Jeroen J Bax, MD, PhD
Leiden University Medical Center
Leiden, The Netherlands
Eric Boersma, PhD
Academisch Ziekenhuis Rotterdam-Dijkzigt
Kamer H 541, Postbus 2040
NL-3000 CA Rotterdam, The Netherlands
Christopher P Cannon, MD
Associate Professor of Medicine
Cardiovascular Division, Department of Medicine
Brigham and Women’s Hospital and Harvard Medical School,
Boston, MA 02115, USA
Michael S Chen, MD
Cleveland Clinic Foundation
Department of Cardiovascular Medicine
9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA
Derek P Chew, MBBS, MPH, FRACP
Department of Cardiovascular Medicine
Flinders Medical Centre
Flinders Way, Bedford Park, South Australia 5042, Australia
Mauricio G Cohen, MD
Assistant Professor of Medicine
Division of Cardiology, Department of Medicine
The University of North Carolina at Chapel Hill
CB #7075, Bioinformatics Building, Suite 4128
130 Mason Farm Road, Chapel Hill, NC 27599, USA
Nicholas LM Cruden, BSc (Hons), MB, ChB, MRCP
Research Fellow, Cardiovascular Research
University of Edinburgh, Chancellor’s Building,
51 Little France Crescent, Edinburgh EH16 4SB, UK
Keith AA Fox, BSc (Hons), MB, ChB, FRCP, FESC
Duke of Edinburgh Professor of Cardiology
Cardiovascular Research, University of Edinburgh
Chancellor’s Building, 51 Little France Crescent
Edinburgh EH16 4SB, UK
Chrisopher B Granger, MD
Associate Professor of Medicine, Director, CCU
Duke Clinical Research Institute, 2400 Pratt St.
Room 0311 Terrace Level, Durham NC 27705, USA
Umair Mallick, MD
Clinical Research Fellow (Cardiology)
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
E Magnus Ohman, MD, FRCPI, FACC
Ernest and Hazel Craige Professor of Cardiovascular Medicine
Chief, Division of Cardiology
Director, UNC Heart Center
The University of North Carolina at Chapel Hill
CB #7075, Bioinformatics Building, Suite 4128
130 Mason Farm Road, Chapel Hill, NC 27599, USA
Jonas Oldgren MD, PhD
Senior Consultant, Head of CCU
Department of Cardiology
Uppsala University Hospital
SE-75185 Uppsala, Sweden
Don Poldermans, MD, PhD
Department of Vascular Surgery
Erasmus Medical Center, Room BA 300
Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Ravish Sachar, MD
Cleveland Clinic Foundation
Department of Cardiovascular Medicine, 9500 Euclid Avenue,
Desk F25, Cleveland, OH 44195, USA
Peter Sinnaeve, MD, PhD
Department of Cardiology
University Hospital Gasthuisberg,
Herestraat 49, 3000 Leuven, Belgium
Anil K Taneja, BSc, MBBS, MRCP(UK), MRCP(Ire), MSc (Card)
Clinical Trials & Evaluation Unit
Britten Street Wing, Royal Brompton Hospital, Sydney Street
London SW3 6NP, UK
Eric J Topol, MD
Provost and Chief Academic Officer
Chairman, Department of Cardiovascular Medicine
Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland,
OH 44195, USA
Frans Van de Werf, MD
Professor, Department of Cardiology,
University Hospital Gasthuisberg,
Herestraat 49, 3000 Leuven, Belgium
Lars Wallentin, MD, PhD
Professor of Cardiology, Director of Uppsala Clinical Research Center
Department of Medical Sciences, Cardiology
and Uppsala Clinical Research Center
Uppsala University Hospital, SE-75185 Uppsala, Sweden
Harvey D White, DSc
Professor, Director of Coronary Care and Cardiovascular Research
Green Lane Hospital, Green Lane Road West
Auckland 1003, New Zealand
Preface
Acute coronary syndromes (ACS) represent a global epidemic. While the
prevalence of risk factors such as diabetes and obesity increase
worldwide, there has been a parallel increase in acute coronary ischemia.
As the leading cause of morbidity and mortality, ACS is a major public
health problem. Research has propelled the field from one driven by
anecdote to one guided by scientific evidence. The real challenge is to
translate advances in treatment into improvements in healthcare.
This book provides the reader with an overview of state of the art
management of ACS. A distinguished international panel of authors
assembled from throughout the world has provided a global view of the
treatment of ACS. Furthermore, the authors provide their insights into
future developments in the field. The full spectrum of ACS, including
both classical ST-segment-elevation myocardial infarction and non-ST
segment-elevation myocardial infarction, as well as unstable angina,
are covered in a comprehensive, evidence-based format. The latest
clinical trials are incorporated into current guidelines to provide
concrete recommendations for the optimal management of ACS.
The book is aimed at the wide range of health care professionals
(including physicians, nurses, pharmacists, and managers) who treat
ACS patients in busy hospitals throughout the world. A broad range of
chapters cover pathophysiology, risk stratification, treatment, and
future directions.
We are grateful to the contributors for distilling an enormous amount of
data into succinct chapters that focus on the essential elements of treating
patients with ACS. We are thankful to Remedica Publishing for producing
this book. It is our sincere hope that readers of our book will obtain a
deeper understanding of ACS that will directly benefit their patients.
Deepak L Bhatt & Marcus D Flather