Pre-hospital treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams. Expert position update 2022

Kubica, Jacek; Adamski, Piotr; Ładny, Jerzy Robert; Kaźmierczak, Jarosław; Fabiszak, Tomasz; Filipiak‬, Krzysztof J.; Gajda, Robert; Gąsior, Mariusz; Gąsior, Zbigniew; Gil, Robert J.; Gorący, Jarosław; Grajek, Stefan; Gromadziński, Leszek; Gruchała, Marcin; Grześk, Grzegorz; Hoffmań, Piotr; Jaguszewski, Miłosz; Janion, Marianna; Jankowski, Piotr; Kalarus, Zbigniew; Kasprzak, Jarosław D.; Kleinrok, Andrzej; Kochman, Wacław; Kubica, Aldona; Kuliczkowski, Wiktor; Legutko, Jacek; Lesiak, Maciej; Nadolny, Klaudiusz; Navarese, Eliano Pio; Niezgoda, Piotr; Ostrowska, Małgorzata; Paciorek, Przemysław; Siller‐Matula, Jolanta M.; Szarpak, Łukasz; Timler, Dariusz; Witkowski, Adam; Wojakowski, Wojciech; Wysokiński, Andrzej; Zielińska, Marzenna

doi:10.5603/cj.a2022.0026

Cited by 9 publications

(7 citation statements)

References 80 publications

(146 reference statements)

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“…In patients presenting with STEMI and CS it is usually difficult to exclude possible contraindications for aggressive antithrombotic treatment in the pre-hospital phase [ 51 ]. In patients with NSTE-ACS routine pretreatment with P2Y12 inhibitors is no longer recommended [ 52 ].…”

Section: Specific Indications For Cangrelormentioning

confidence: 99%

Cangrelor — Expanding therapeutic options in patients with acute coronary syndrome

Kubica,

Adamski,

Dobrzycki

et al. 2024

Cardiol J.

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Cangrelor is the only intravenous P2Y12 receptor antagonist. It is an adenosine triphosphate analog that selectively, directly, and reversibly binds to the platelet P2Y12 receptors exerting its antiaggregatory effect. Cangrelor is characterized by linear, dose-dependent pharmacokinetics and rapid onset of action providing potent platelet inhibition exceeding 90%. Cangrelor is rapidly metabolized by endothelial endonucleotidase; thus, its half-life is 2.9 to 5.5 min, and its antiplatelet effect subsides within 60 to 90 min. Data originating from three pivotal cangrelor trials (CHAMPION PLATFORM, CHAMPION PCI, and CHAMPION PHOENIX) indicate that cangrelor reduces the risk of periprocedural thrombotic complications during percutaneous coronary intervention at the expense of mild bleedings. Its unique pharmacological properties allow it to overcome the limitations of oral P2Y12 receptor inhibitors, mainly related to the delayed and decreased bioavailability and antiplatelet effect of these agents, which are often observed in the setting of acute coronary syndrome. Subgroups of patients who could theoretically benefit the most from cangrelor include those in whom pharmacokinetics and pharmacodynamics of oral P2Y12 receptor antagonists are most disturbed, namely patients with ST-segment elevation myocardial infarction, those treated with opioids, with mild therapeutic hypothermia, or in cardiogenic shock. Cangrelor could also be useful if bridging is required in patients undergoing surgery. According to the current guidelines cangrelor may be considered in P2Y12 receptor inhibitor-naïve patients undergoing percutaneous coronary intervention in both acute and stable settings.

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Section: Specific Indications For Cangrelormentioning

confidence: 99%

Cangrelor — Expanding therapeutic options in patients with acute coronary syndrome

Kubica,

Adamski,

Dobrzycki

et al. 2024

Cardiol J.

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“…Terapi kombinasi dua anti platelet yaitu asam asetilsalisilat dan inhibitor P2Y12 (clopidgrel) merupakan standar perawatan pada pasien sindrom koroner akut. Kombinasi antiplatelet (aspilet + clopidogrel) direkomendasikan pada pasien NSTEMI, kecuali terdapat kontraindikasi misalnya resiko perdarahan yang berlebihan (kelas rekomendasi I, level evidence A) (Kubica et al, 2022). Terapi pada pasien NSTEMI dan UAP selama menjalani rawat inap di RS PKU Muhammadiyah Gamping adalah dual antiplatelet yaitu aspilet 80 mg 197 (87.9 %) dan clopidogrel 75 mg 202 (90.2 %).…”

Section: Hasil Dan Pembahasanunclassified

Karakteristik Pasien Nstemi (Non St Segment Elevation Myocardial Infarction) Dan Uap (Unstable Angina Pectoris) Yang Dirawat Inap Di Rs Pku Muhammadiyah Gamping Periode 1 Januari 2018 - 31 Desember 2020

Wiwit Herawati,

Akrom,

Joko Sudibyo

2023

jofar

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Sindrom Koroner Akut mengacu pada sekelompok kondisi yang mencakup ST Segment Elevation Myocardial Infarction (STEMI), Non ST Segment Elevation Myocardial Infarction (NSTEMI) dan Unstable Angina Pectoris (UAP). NSTEMI didefinisikan sebagai peningkatan biomarker jantung dengan tidak adanya segmen elevasi ST yang persisten. NSTEMI dan UAP memiliki gejala serupa dimana perbedaan NSTEMI dengan UAP adalah pada NSTEMI terjadi peningkatan troponin. Dengan diketahuinya data karakteristik pasien NSTEMI dan UAP, pencegahan terjadinya komplikasi bisa diminimalkan, mengurangi faktor risiko yang bisa memperburuk prognosis pasien dan meningkatkan kualitas hidup. Penelitian ini bertujuan untuk mengetahui karakteristik pasien NSTEMI dan UAP yang dirawat inap di Rumah Sakit PKU Muhammadiyah Gamping Periode 1 Januari 2018 -31 Desember 2020. Metode penelitian yang digunakan adalah cross sectional menggunakan data retrospektif dengan jenis penelitian observasional analitik. Pengambilan sampel dilakukan dengan menggunakan purposive sampling dan didapatkan sampel sebanyak 224 pasien yang menjalani rawat inap. Jumlah tersebut sudah memenuhi kriteria menurut OpenEpi dimana jumlah minimal adalah 164 pasien. Data yang diperoleh dianalisis dengan IBM SPSS versi 20. Analisis chi square digunakan untuk melihat perbandingan antara variabel bebas antara lain riwayat komorbid diabetes mellitus, riwayat komorbid hipertensi, riwayat komorbid dislipidemia dengan variabel terikat yaitu lama rawat inap pada pasien NSTEMI dan UAP. Penderita NSTEMI dan UAP terbanyak terdiri dari pasien yang berusia > 45 tahun. Riwayat komorbid terbanyak adalah hipertensi. Pemberian terapi terbanyak di UGD mencakup oksigen 81.3 %, infus NaCl 0.9 % 62.1 %, clopidogrel 75 mg 57.6 %, aspilet 80 mg 57.1 %, inviclot 49.6 % dan ISDN 5 mg 25.0 %. Pemberian terapi terbanyak di rawat inap adalah clopidogrel 75 mg 90.2 %, aspilet 80 mg 87.9 %, atorvastatin 40 mg 74.6 %, alprazolam 0.5 mg 70.1 %, bisoprolol 2.5 mg 45.1 %, dan furosemide injeksi 17.9 %. Pasien NSTEMI dan UAP yang mempunyai komorbiditas diabetes mellitus berpeluang 0.41 kali untuk menjalani perawatan kurang / sama dengan 5 hari jika dibandingkan dengan yang tidak punya komorbiditas diabetes mellitus, dan secara statistik bermakna (P = 0.02).

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“…A diagnosis of acute myocardial infarction (AMI) is often suspected from the clinical history. In such cases, the ECG is the first-line investigation and should be recorded in the pre-hospital environment 3. This will identify an ST elevation myocardial infarction (STEMI), which is indicative of acute coronary occlusion, in some patients.…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, the ECG is the first-line investigation and should be recorded in the pre-hospital environment. 3 This will identify an ST elevation myocardial infarction (STEMI), which is indicative of acute coronary occlusion, in some patients. Patients with STEMI require immediate revascularisation and should be transported to a heart attack centre.…”

Section: Introductionmentioning

confidence: 99%

External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting

et al. 2023

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ObjectivesThe Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment.MethodsWe undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as ‘normal’ or ‘abnormal’). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital.ResultsOf 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV.ConclusionNeither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to ‘rule in’ or ‘rule out’ NSTEMI alone.

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Pre-hospital treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams. Expert position update 2022

Cited by 9 publications

References 80 publications

Cangrelor — Expanding therapeutic options in patients with acute coronary syndrome

Cangrelor — Expanding therapeutic options in patients with acute coronary syndrome

Karakteristik Pasien Nstemi (Non St Segment Elevation Myocardial Infarction) Dan Uap (Unstable Angina Pectoris) Yang Dirawat Inap Di Rs Pku Muhammadiyah Gamping Periode 1 Januari 2018 - 31 Desember 2020

External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting

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