Acute coronary syndrome
Spectrum of acute coronary artery disease: unstable angina, non-ST-elevation MI (NSTEMI), and ST-elevation MI (STEMI). ESC 2023 base therapy includes reperfusion (primary PCI for STEMI within 120 minutes; early invasive strategy in NSTEMI with risk factors), dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor: ticagrelor, prasugrel, or clopidogrel), anticoagulation, β-blockers, statins, and ACE inhibitors or ARBs.
ICD-10 I20-I222 drugs
Also known as: ACS, Myocardial infarction, Unstable angina
Drugs used for this condition
- ANitroglycerinFirst line · Organic nitrateSublingual or intravenous nitroglycerin is used in acute coronary syndrome to reduce myocardial ischemia, control hypertension, and relieve pulmonary congestion. Intravenous infusion (start at 5–10 mcg/min, titrate to BP and pain) is indicated for ongoing ischemia, hypertension, or heart failure. Avoided in systolic BP below 90 mm Hg, right-ventricular infarction, and after recent phosphodiesterase-5 inhibitor use.
- ATicagrelorFirst line · Reversible P2Y12 receptor inhibitorFirst-line in dual antiplatelet therapy for acute coronary syndrome (NSTEMI, STEMI, unstable angina) per ESC 2023 alongside prasugrel. Compared with clopidogrel, PLATO showed 16% reduction in cardiovascular death, MI, and stroke (NNT 53) without an increase in non-CABG major bleeding. Loading dose 180 mg; maintenance 90 mg twice daily for 12 months with aspirin 75–100 mg once daily.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit