Overview
Acute Coronary Syndrome
1. Clinical Overview
Summary
Acute coronary syndrome (ACS) encompasses unstable angina, NSTEMI, and STEMI. All result from acute coronary plaque rupture and thrombosis. STEMI requires immediate reperfusion (primary PCI within 120 minutes). NSTEMI and unstable angina are managed with antithrombotic therapy and early invasive strategy based on risk. Diagnosis requires ECG and troponin. DAPT (aspirin + P2Y12 inhibitor), anticoagulation, and timely revascularisation are key.
Key Facts
- Classification: STEMI (ST elevation), NSTEMI (troponin rise), UA (no biomarker rise)
- Pathology: Plaque rupture, thrombosis
- Emergency: STEMI → call cathlab immediately
2. Diagnosis
| Feature | STEMI | NSTEMI | UA |
|---|---|---|---|
| ECG | ST elevation / new LBBB | ST depression, T wave inversion | Normal or non-specific |
| Troponin | Elevated | Elevated | Normal |
3. Management
STEMI
- Primary PCI within 120 minutes (door-to-balloon)
- Aspirin 300mg + ticagrelor/prasugrel + anticoagulation
- If PCI not available in time: thrombolysis (then rescue PCI if needed)
NSTEMI/UA
- Aspirin 300mg + ticagrelor/clopidogrel
- Fondaparinux (or heparin)
- Early invasive strategy (angiography) based on GRACE score
Secondary Prevention
- DAPT for 12 months
- Statin (high intensity)
- Beta-blocker
- ACEi
- Lifestyle modification
4. References
-
NICE Guideline NG185. Acute coronary syndromes. 2020.
-
Ibanez B et al. 2017 ESC Guidelines for STEMI. Eur Heart J. 2018;39(2):119-177. PMID: 28886621
Last Reviewed: 2026-01-01 | MedVellum Editorial Team