Acute coronary syndromes — pharmacological treatment

By Gary Fletcher, BSc, MRPharmS, and Andrew Worrall, MBChB, MRCP

Gary Fletcher is principal pharmacist, cardiothoracic services, Royal Wolverhampton Hospitals NHS Trust

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SUMMARY

The term acute coronary syndrome (ACS) describes the spectrum of disease from acute myocardial infarction (MI) to unstable angina, as described in the first article of this feature (p285).

The primary cause of these diseases is essentially the same — thrombosis of a coronary artery leading to ischaemia and possibly infarction of the myocardium. The degree of ischaemia or infarct size is related to the degree and location of the thrombosis.

Since the 1960s, when standard treatment was bed rest and defibrillation (when required), the death rate from acute MI has fallen. This steady decline in mortality has been due to a number of factors:

• Improved public information and education about the need to seek immediate medical attention when suspected cardiac chest pain is experienced

• The introduction of new drug treatments (eg, beta blockers in the late 1970s)

• The introduction of thrombolytic agents (in the 1980s)

• The development of coronary angioplasty and stenting (in the 1990s)

• The recognition of modifiable risk factors (eg, hypertension, diabetes, smoking) and strategies for their management

This article will review current drug treatments for ACS and the growing significance of primary percutaneous coronary intervention (PCI) as an alternative to thrombolysis in acute MI.

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