Basics ACS Management

• ACS management:

  • unstable angina and NSTEMI share a common pathological basis – the only fundamental difference being that in unstable angina, the atherothrombotic complex is not large enough to cause any cellular / tissue death, whereas in NSTEMI the atherothrombotic complex obstructs enough blood flow to cause some tissue death
  • So regardless of whether a patient has a diagnosed NSTEMI or unstable angina they will be managed in the same way
• ACS management:

  • The first thing that needs to be done following diagnosis is to determine whether the patient is a high / intermediate risk patient
  • Determining a patient’s risk determines the aggressiveness of the management pathway they will follow
  • There are a variety of tools to assess patient risk for example the TIMI or the Grace scoring system
  • Both are commonly used
• The Grace system:

  • The Grace system is recommended by NICE guidelines
  • The Grace system uses patient data to quantify risk of death in the very early (in-hospital) period and to quantify risk of death in the first 6 months and 3 years post infarction
  • The higher a patient’s risk of early death the more aggressive and less conservative management is likely to be
  • A high risk patient is more likely to be recommended for surgery