Acute coronary syndrome (ACS) refers to a spectrum of acute myocardial ischemia and/or infarction. Acute chest pain is the leading presenting symptom; all patients with chest pain require urgent evaluation. ECG should not be delayed in the patient with suspected ACS. Myocardial biomarkers, such as high-sensitivity cardiac troponins, play a complementary role in the diagnosis; subsequent/serial measurements may be needed. Other tests are indicated according to clinical context.[1]
Classically ACS has been divided into three clinical categories.[2] [3] In ST-elevation myocardial infarction (STEMI) the ECG shows persistent ST-segment elevation in two or more anatomically contiguous leads. Unstable angina and non-ST-elevation myocardial infarction (NSTEMI) represent a continuum of pathology, differing mainly by the presence of markers of myocardial damage in NSTEMI.[1] Therefore some guidelines have grouped unstable angina and NSTEMI as "non-ST-elevation acute coronary syndromes".
Strong risk factors for ACS include smoking, hypertension, diabetes mellitus, obesity and metabolic syndrome, sedentary behavior and physical inactivity, dyslipidemia, chronic kidney disease, atherosclerosis, family history of premature coronary artery disease, age >60 years, cocaine use, and depression.
