Víctor A. Enríquez-Martínez, Servicio de Cardiología, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
The non-ST-segment elevation acute coronary syndrome comprises both non-ST-elevation myocardial infarction and unstable angina. Clinically, it presents retrosternal oppressive chest pain or equivalents such as dyspnea. Its diagnosis requires an electrocardiogram within the first 10 minutes of medical contact, which may show ST-segment depression or other variable abnormalities, followed by the measurement of high-sensitivity cardiac troponin with 1 to 2 hours protocols in case of diagnostic uncertainty. Initial medical treatment includes antiplatelet therapy with aspirin, a P2Y12 inhibitor, and parenteral anticoagulation. Risk stratification is performed using scores such as GRACE or TIMI, as well as clinical criteria, to determine the invasive strategy and timing. Discharge treatment is based on dual antiplatelet therapy for 12 months, high-intensity statins to achieve an LDL-c target of < 55 mg/dL, and ACE inhibitors or ARBs. Beta-blockers are no longer routinely used long-term in revascularized patients with a left ventricular ejection fraction ≥ 50%. Finally, patient education and cardiac rehabilitation programs significantly reduce mortality and readmissions.
Keywords: NSTE-ACS. Unstable angina. Troponin. GRACE. Risk stratification. Management.