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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
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Content Update
AEGIS-II Trial: Apolipoprotein A1 Infusions and Cardiovascular Outcomes after Acute Myocardial Infarction
This phase 3 randomized, placebo-controlled trial assessed the efficacy and safety of CSL112, a human plasma-derived apolipoprotein A1 that increases cholesterol efflux capacity, in high-risk patients (multivessel coronary artery disease, and pharmacologic treatment of diabetes or two additional risk factors: age 65 years or older, history of MI, peripheral artery disease) after acute myocardial infarction (MI). Read More
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Content Update
EMPACT-MI Trial Review
The EMPACT-MI investigators evaluated whether the addition of empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, to the standard treatment for acute myocardial infarction (AMI) affected future mortality or heart failure (HF) in at-risk patients. Read More
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Content Update
ECLS-SHOCK Trial Review
The ECLS-SHOCK trial evaluated the impact of extracorporeal life support (ECLS) on mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. Read More
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Content Update
OCT versus IVUS versus angiography guidance: a real-time updated network meta-analysis
This network meta-analysis comprised 20 randomized trials of percutaneous coronary intervention (PCI) guided by intravascular imaging (IVI) compared with angiography guidance alone. Read More
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Content Update
BIOVASC: Immediate Versus Staged Complete Revascularization in ACS and Multivessel Disease
The BIOVASC trial was a prospective, open-label, non-inferiority, randomized, multinational clinical trial designed to assess whether immediate versus staged (within 6 weeks after the index procedure) complete revascularization improves outcomes in patients with acute coronary syndromes (ACS) and multivessel coronary disease. Read More
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Content Update
SECURE Trial
The SECURE trial is an open-label, multinational trial that randomized 2,499 patients aged ≥65 years with a prior type 1 myocardial infarction (MI) within the 6 months preceding enrollment to a polypill-based strategy with a single pill containing aspirin (100 mg), ramipril (2.5, 5 or 10 mg) and atorvastatin (20 or 40 mg), or to usual care. Read More
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Content Update
PACMAN-AMI: Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction
The PACMAN-AMI trial sought to evaluate effects of PCSK9 inhibition on atherosclerotic plaque progression via serial intracoronary imaging of non-culprit plaques in patients presenting with acute myocardial infarction (MI) on high-intensity statin therapy. Read More
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Chapter Summary
This chapter discusses the pathophysiology, epidemiology, diagnosis, and treatment of non–ST-segment elevation acute coronary syndromes (see Fuster and Hurst’s Central Illustration). The most common etiology is disruption of an atherosclerotic coronary artery plaque with subsequent platelet-rich thrombus formation that may be flow limiting, but usually does not completely occlude the coronary lumen. Downstream microembolization of platelet aggregates and components of the disrupted plaque are likely responsible for the release of myocardial injury biomarkers. The clearest separation between unstable angina (UA) and non–ST-segment elevation myocardial infarction (NSTEMI) is the absence or presence of abnormal concentrations of myocardial biomarkers. The aims of therapy are to relieve ischemia, control symptoms, and prevent complications. Nitrates, β-blockers, ...