Acute Coronary Syndrome


The first edition of this text was published in 2003 when acute coronary syndrome had become a well-defined clinical entity decades after clinical observations on premonitory symptoms preceding myocardial infarction and sudden death. The syndrome demarcates the acute unstable life- threatening manifestations of coronary atherosclerosis from the silent/stable manifestations of the disease. The bridge between the two conditions is the unstable plaque; diagnostic clues to the presence of such plaques are progressive angina, ST-T changes, and cardiac troponin elevation, all indicators of evolving ischemia. The opportunity to recognize patients at risk and prevent myocardial infarction and cardiac death set the stage for a wealth of fundamental and clinical research on the epidemiology and pathophysiology of dynamic atherosclerosis. It set a model for testing interventions aimed at preventing progression of the disease taking profit from the art of clinical trials being in full expansion. The sample size and event rates were there. Patients with chest pain and acute coronary syndromes indeed populated emergency departments and coronary care units, carrying a high-risk of acute ischemic events and recurrence of an event in the following months. Accordingly, the first edition of this text was mainly didactic and focused on prevalence, pathophysiology, diagnostic methods, and medical management and interventional procedures. It also included coverage of sub- groups, secondary prevention, and guidelines recommendations for management. 

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