Akut Koroner Sendromlar
Özet
Akut koroner sendromlar (AKS) çok geniş bir klinik yelpazede karşımıza çıkabilirler. Kardiyak arrestten başvuru anında asemptomatik göğüs ağrısı öyküsü olan tablo arasında dağılım gösterebilir. Ana kardiyak yakınma çoğu zaman göğüste sıkıştırıcı vasıflı baskı hissi şeklindeki göğüs ağrısıdır. Eşdeğer yakınma olarak nefes darlığı, epigastrik ağrı veya sol kolda ağrı şeklinde de ortaya çıkabilir. Göğüs ağrısı ve ilişki semptomlar ABD’de 2020 yılında yaklaşık 7,2 milyon başvuru ile acile ikinci en sık başvuru nedenidir. Genellikle acile başvuran tüm göğüs ağrısı sebepleri içerisinde ise AKS %5.1 oranındadır ve göğüs ağrısının yarısından fazlası kardiyak dışı sebeplerden kaynaklanmaktadır. Hastaların başvuru şikayetleri, Elektrokardiyogram(EKG) değerlendirmesi, hemodinamik durumu, muayene bulguları, laboratuvar ve görüntüleme testleri sonucunda belli ön tanılara göre ilerlenir. AKS tanısı dışında acil tedavi gerektiren AKS dışı aort diseksiyonu, pulmoner tromboemboli, pnömotoraks gibi klinik durumlara ve AKS tedavisine diğer bölümlerde değinilmiştir. Bu bölümde AKS tanısı anlatılmaya çalışılacaktır.
Referanslar
Roffi M, Patrono C, Collet JP, et al. [2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)]. G Ital Cardiol (Rome). 2016; 17: 831-72.
National Hospital Ambulatory Medical Care Survey: 2020 Emergency Department Summary Tables. In: National Center for Health S, ed. Hyattsville, MD: https://dx.doi.org/10.15620/cdc:121911, 2022.
Hsia RY, Hale Z, Tabas JA. A National Study of the Prevalence of Life-Threatening Diagnoses in Patients With Chest Pain. JAMA Intern Med. 2016; 176: 1029-32.
Mosca L, Linfante AH, Benjamin EJ, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005; 111: 499-510.
van Oosterhout REM, de Boer AR, Maas A, et al. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc. 2020; 9: e014733.
Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015; 36: 1163-70.
Jennings RB, Ganote CE. Structural Changes in Myocardium During Acute Ischemia. Circ Res. 1974; 35: III-156-III-72.
Virmani R, Forman MB, Kolodgie FD. Myocardial reperfusion injury. Histopathological effects of perfluorochemical. Circulation. 1990; 81: IV57-68.
Reimer KA, Jennings RB, Tatum AH. Pathobiology of acute myocardial ischemia: Metabolic, functional and ultrastructural studies. Am J Cardiol. 1983; 52: 72-81.
Ibáñez B, Heusch G, Ovize M, et al. Evolving Therapies for Myocardial Ischemia/Reperfusion Injury. J Am Coll Cardiol. 2015; 65: 1454-71.
Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J. 2015; 37: 1268-83.
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72: 2231-64.
Bentzon JF, Otsuka F, Virmani R, et al. Mechanisms of Plaque Formation and Rupture. Circulation Research. 2014; 114: 1852-66.
Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2012; 34: 719-28.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017; 39: 119-77.
Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2020; 42: 1289-367.
Zeitouni M, Silvain J, Guedeney P, et al. Periprocedural myocardial infarction and injury in elective coronary stenting. Eur Heart J. 2018; 39: 1100-09.
Thygesen K, Jaffe AS. The prognostic impact of periprocedural myocardial infarction and injury. Eur Heart J. 2018; 39: 1110-12.
Garcia-Garcia HM, McFadden EP, Farb A, et al. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Eur Heart J. 2018; 39: 2192-207.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 144: e368-e454.
Nikolaou NI, Arntz HR, Bellou A, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation. 2015; 95: 264-77.
Rubini Gimenez M, Reiter M, Twerenbold R, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med. 2014; 174: 241-9.
Persson A, Hartford M, Herlitz J, et al. Long-term prognostic value of mitral regurgitation in acute coronary syndromes. Heart. 2010; 96: 1803-8.
Nestelberger T, Boeddinghaus J, Badertscher P, et al. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J Am Coll Cardiol. 2017; 70: 1558-68.
Shah ASV, Anand A, Strachan FE, et al. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. The Lancet. 2018; 392: 919-28.
Mandelzweig L, Battler A, Boyko V, et al. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006; 27: 2285-93.
Zimetbaum PJ, Josephson ME. Use of the Electrocardiogram in Acute Myocardial Infarction. N Engl J Med. 2003; 348: 933-40.
Wang K, Asinger RW, Marriott HJL. ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction. N Engl J Med. 2003; 349: 2128-35.
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med. 1996; 334: 481-7.
Wong CK, French JK, Aylward PE, et al. Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes. J Am Coll Cardiol. 2005; 46: 29-38.
Nestelberger T, Cullen L, Lindahl B, et al. Diagnosis of acute myocardial infarction in the presence of left bundle branch block. Heart. 2019; 105: 1559-67.
Madias JE. The nonspecificity of ST-segment elevation > or =5.0 mm in V1-V3 in the diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. J Electrocardiol. 2004; 37: 135-9.
Yan AT, Yan RT, Kennelly BM, et al. Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. Am Heart J. 2007; 154: 71-8.
Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012; 33: 2252-7.
Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010; 31: 2197-204.
Rittoo D, Jones A, Lecky B, et al. Elevation of Cardiac Troponin T, But Not Cardiac Troponin I, in Patients With Neuromuscular Diseases: Implications for the Diagnosis of Myocardial Infarction. J Am Coll Cardiol. 2014; 63: 2411-20.
Jaffe AS, Vasile VC, Milone M, et al. Diseased Skeletal Muscle: A Noncardiac Source of Increased Circulating Concentrations of Cardiac Troponin T. J Am Coll Cardiol. 2011; 58: 1819-24.
Wens SCA, Schaaf GJ, Michels M, et al. Elevated Plasma Cardiac Troponin T Levels Caused by Skeletal Muscle Damage in Pompe Disease. Circ Cardiovasc Genet. 2016; 9: 6-13.
Vestergaard KR, Jespersen CB, Arnadottir A, et al. Prevalence and significance of troponin elevations in patients without acute coronary disease. Int J Cardiol. 2016; 222: 819-25.
Schmid J, Liesinger L, Birner-Gruenberger R, et al. Elevated Cardiac Troponin T in Patients With Skeletal Myopathies. J Am Coll Cardiol. 2018; 71: 1540-49.
Hess EP, Perry JJ, Ladouceur P, et al. Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. CJEM. 2010; 12: 128-34.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64: e139-e228.
Scirica BM. Acute coronary syndrome: emerging tools for diagnosis and risk assessment. J Am Coll Cardiol. 2010; 55: 1403-15.
Lewis WR. Echocardiography in the evaluation of patients in chest pain units. Cardiol Clin. 2005; 23: 531-9, vii.
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012; 126: 3097-137.
Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122: 1756-76.
Beek AM, van Rossum AC. Cardiovascular magnetic resonance imaging in patients with acute myocardial infarction. Heart. 2010; 96: 237-43.
Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol. 2009; 55: 1-16.
Referanslar
Roffi M, Patrono C, Collet JP, et al. [2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)]. G Ital Cardiol (Rome). 2016; 17: 831-72.
National Hospital Ambulatory Medical Care Survey: 2020 Emergency Department Summary Tables. In: National Center for Health S, ed. Hyattsville, MD: https://dx.doi.org/10.15620/cdc:121911, 2022.
Hsia RY, Hale Z, Tabas JA. A National Study of the Prevalence of Life-Threatening Diagnoses in Patients With Chest Pain. JAMA Intern Med. 2016; 176: 1029-32.
Mosca L, Linfante AH, Benjamin EJ, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005; 111: 499-510.
van Oosterhout REM, de Boer AR, Maas A, et al. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc. 2020; 9: e014733.
Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015; 36: 1163-70.
Jennings RB, Ganote CE. Structural Changes in Myocardium During Acute Ischemia. Circ Res. 1974; 35: III-156-III-72.
Virmani R, Forman MB, Kolodgie FD. Myocardial reperfusion injury. Histopathological effects of perfluorochemical. Circulation. 1990; 81: IV57-68.
Reimer KA, Jennings RB, Tatum AH. Pathobiology of acute myocardial ischemia: Metabolic, functional and ultrastructural studies. Am J Cardiol. 1983; 52: 72-81.
Ibáñez B, Heusch G, Ovize M, et al. Evolving Therapies for Myocardial Ischemia/Reperfusion Injury. J Am Coll Cardiol. 2015; 65: 1454-71.
Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J. 2015; 37: 1268-83.
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72: 2231-64.
Bentzon JF, Otsuka F, Virmani R, et al. Mechanisms of Plaque Formation and Rupture. Circulation Research. 2014; 114: 1852-66.
Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2012; 34: 719-28.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017; 39: 119-77.
Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2020; 42: 1289-367.
Zeitouni M, Silvain J, Guedeney P, et al. Periprocedural myocardial infarction and injury in elective coronary stenting. Eur Heart J. 2018; 39: 1100-09.
Thygesen K, Jaffe AS. The prognostic impact of periprocedural myocardial infarction and injury. Eur Heart J. 2018; 39: 1110-12.
Garcia-Garcia HM, McFadden EP, Farb A, et al. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Eur Heart J. 2018; 39: 2192-207.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 144: e368-e454.
Nikolaou NI, Arntz HR, Bellou A, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation. 2015; 95: 264-77.
Rubini Gimenez M, Reiter M, Twerenbold R, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med. 2014; 174: 241-9.
Persson A, Hartford M, Herlitz J, et al. Long-term prognostic value of mitral regurgitation in acute coronary syndromes. Heart. 2010; 96: 1803-8.
Nestelberger T, Boeddinghaus J, Badertscher P, et al. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J Am Coll Cardiol. 2017; 70: 1558-68.
Shah ASV, Anand A, Strachan FE, et al. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. The Lancet. 2018; 392: 919-28.
Mandelzweig L, Battler A, Boyko V, et al. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006; 27: 2285-93.
Zimetbaum PJ, Josephson ME. Use of the Electrocardiogram in Acute Myocardial Infarction. N Engl J Med. 2003; 348: 933-40.
Wang K, Asinger RW, Marriott HJL. ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction. N Engl J Med. 2003; 349: 2128-35.
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med. 1996; 334: 481-7.
Wong CK, French JK, Aylward PE, et al. Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes. J Am Coll Cardiol. 2005; 46: 29-38.
Nestelberger T, Cullen L, Lindahl B, et al. Diagnosis of acute myocardial infarction in the presence of left bundle branch block. Heart. 2019; 105: 1559-67.
Madias JE. The nonspecificity of ST-segment elevation > or =5.0 mm in V1-V3 in the diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. J Electrocardiol. 2004; 37: 135-9.
Yan AT, Yan RT, Kennelly BM, et al. Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. Am Heart J. 2007; 154: 71-8.
Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012; 33: 2252-7.
Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010; 31: 2197-204.
Rittoo D, Jones A, Lecky B, et al. Elevation of Cardiac Troponin T, But Not Cardiac Troponin I, in Patients With Neuromuscular Diseases: Implications for the Diagnosis of Myocardial Infarction. J Am Coll Cardiol. 2014; 63: 2411-20.
Jaffe AS, Vasile VC, Milone M, et al. Diseased Skeletal Muscle: A Noncardiac Source of Increased Circulating Concentrations of Cardiac Troponin T. J Am Coll Cardiol. 2011; 58: 1819-24.
Wens SCA, Schaaf GJ, Michels M, et al. Elevated Plasma Cardiac Troponin T Levels Caused by Skeletal Muscle Damage in Pompe Disease. Circ Cardiovasc Genet. 2016; 9: 6-13.
Vestergaard KR, Jespersen CB, Arnadottir A, et al. Prevalence and significance of troponin elevations in patients without acute coronary disease. Int J Cardiol. 2016; 222: 819-25.
Schmid J, Liesinger L, Birner-Gruenberger R, et al. Elevated Cardiac Troponin T in Patients With Skeletal Myopathies. J Am Coll Cardiol. 2018; 71: 1540-49.
Hess EP, Perry JJ, Ladouceur P, et al. Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. CJEM. 2010; 12: 128-34.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64: e139-e228.
Scirica BM. Acute coronary syndrome: emerging tools for diagnosis and risk assessment. J Am Coll Cardiol. 2010; 55: 1403-15.
Lewis WR. Echocardiography in the evaluation of patients in chest pain units. Cardiol Clin. 2005; 23: 531-9, vii.
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012; 126: 3097-137.
Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122: 1756-76.
Beek AM, van Rossum AC. Cardiovascular magnetic resonance imaging in patients with acute myocardial infarction. Heart. 2010; 96: 237-43.
Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol. 2009; 55: 1-16.
