Management of Acute Coronary Syndromes / Edition 1

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Overview

In this second edition of his highly acclaimed book, Christopher P. Cannon, MD, and a team of preeminent clinical investigators have thoroughly revised and expanded every chapter to reflect the recent explosion of clinical trials on the management of acute coronary syndromes (ACS). This includes: the newer tests, such as C reactive protein; a multimarker approach to diagnosis and risk stratification; new antiplatelet agents; and combinations of thrombolytic-antithrombotic regimens. Also discussed are the latest developments in interventional cardiology, the use of cost-effectiveness in clinical trials to choose appropriate therapies, and the employment of critical pathways analysis to improve compliance with evidence-based medicine and guideline recommendations.

The book contains predominantly black-and-white illustrations, with some color illustrations.

This book defines and illustrates the new paradigm of acute coronary syndromes, defining acute myocardial infarction and unstable angina as part of a spectrum of myocardial ischemia. It presents the current state-of-the-art management of the disease including aggressive thrombolytic, andithrombotic, and interventional approaches.

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Editorial Reviews

Keith McLean
This extremely well written and concise book covers unstable angina, ST segment elevation infarction, and ST segment depression infarction. It focuses on the pathophysiology, including cytokines and molecular biology of these syndromes. It gives evidence-based rationale for therapy with medications, thrombolytics, and angioplasty and also focuses on important adjunctive therapies, specifically with regard to antiplatelet agents. The purpose is to understand the pathophysiology of acute coronary syndromes from the microscopic to the macroscopic level and to apply this knowledge in treating patients with the wide spectrum of the disease process. It clearly separates ST segment elevation infarction from SI segment depression infarction and thoroughly explores the pathophysiologic differences, which are essential for rational treatment strategies. This book is written primarily for cardiologists and general internists, but is also an excellent source of information for medical students, internal medicine residents, and cardiology fellows. It stands by itself with extensive references from well known clinical studies that have formed the basis for clinical practice. This is an excellent and concise review of the spectrum of unstable angina, ST segment elevation infarction, and ST segment depression infarction. It focuses on the pathophysiology of the process with special emphasis on the role of inflammation, cytokines, and molecular biology. It also explains the biology of the process and resultant treatment implications. It spends a good deal of time on explaining the serum markers for myocardial ischemia as well as their pathophysiologic differences between ST elevation and STdepression infarction and the rationale for specific treatment strategies. Data on primary angioplasty and the thrombolytic trials are reviewed in detail. The importance of risk stratification is not overlooked nor is the importance of adjunctive therapy for myocardial inflection with beta blockers and angiotensin converting enzyme inhibitors. The numerous tables and charts are well designed and emphasize important topics covered in the text. There is also a specific chapter on novel agents in the treatment of MI and a review of the essential role of the platelet in the process as well as some of the newer antiplatelet agents. Specific topics such as myocardial infarction in younger patients with major emphasis on other factors such as homocysteine and Lp(a) are also covered. This book is an excellent summary of acute coronary syndromes. It is well thought out and easy to read, which allows the reader to assimilate a lot of information in a short period of time. Its clear writing and effective use of tables and graphics solidifies understanding this essential topic in cardiology. Compared with a similar book, Acute Coronary Syndromes, edited by Eric J. Topol (Marcel Dekker, 1998), this book seems to present the data in a more concise and reader-friendly fashion.
Booknews
Twenty-six articles draw on recent results of clinical trials to explain guidelines for patients with ST- and non-ST- elevation myocardial ischemia (MI), as well as to explore the pathophysiology and diagnosis of acute coronary syndrome (ACS). Subjects include information on thrombolytic therapy, risk stratification, antiplatelet and antithrombotic agents, a comparison of invasive versus conservative strategies, and primary angioplasty. A final section deals with special issues such as ACS and women, MI in younger patients, cardiogenic shock, cholesterol lowering, cost-effectiveness analysis in treatment, and secondary prevention of MI. Annotation c. by Book News, Inc., Portland, Or.
Doody's Review Service
Reviewer: Leslie Cho, MD (Loyola University Stritch School of Medicine)
Description: This book provides a full review of acute coronary syndromes (ACS) from pathophysiology to management.
Purpose: The purpose is to provide a comprehensive review of ACS using the new paradigm of ST elevation MI vs. non-ST elevation MI. The book provides a good review of the pathophysiology, diagnosis, treatment, and prevention of this wide spectrum of syndromes. Since this is an ever changing field, such a book could potentially provide a comprehensive review of pertinent literature. This book is adequate in providing a comprehensive review of literature, but in many of the chapters it regurgitates trial information without providing any further insight.
Audience: The book is mainly for residents, cardiology fellows, and cardiologists, as well as emergency physicians and residents. Some authors are recognized authorities in the field while others appear to be fellows.
Features: The book is a good comprehensive review of ACS. However, unlike the stated goal it is not up to the minute and, unfortunately, no book can be since this field is changing at a rapid rate. The major shortcoming of the book is that in some chapters, there is a mere regurgitation of trial data without a good synthesis of the information. There are other ACS books out there (Topol's Acute Coronary Syndromes, 2nd edition (Marcel Dekker, 2001), etc.) and for the most part all these books are similar.
Assessment: This is a useful and good book, but it is not as good as it could have been because of the regurgitation of trial data without synthesis of the findings. A second edition is warranted because the field is changing rapidly.

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780896035522
  • Publisher: Springer-Verlag New York, LLC
  • Publication date: 11/28/1998
  • Series: Contemporary Cardiology Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 659
  • Product dimensions: 7.34 (w) x 10.45 (h) x 1.75 (d)

Table of Contents

Foreword
Preface
Contributors
Pt. I Pathophysiology
1 The Spectrum of Myocardial Ischemia: The Paradigm of Acute Coronary Syndromes 3
2 Linking Biochemistry, Vascular Biology, and Clinical Events in Acute Coronary Syndromes 19
3 Triggers of Acute Coronary Syndromes 61
4 Insights into the Pathophysiology of Acute Ischemia Syndromes Using the TIMI Flow Grade, TIMI Frame Count, and TIMI Myocardial Perfusion Grade 95
Pt. II Diagnosis
5 Emergency Department Presentations of Acute Cardiac Ischemia 121
6 Early Identification and Treatment of Patients with Acute Coronary Syndromes 157
7 Serum Markers for Diagnosis and Risk Stratification in Acute Coronary Syndromes 183
8 Technologies to Diagnose Acute Ischemia 211
Pt. III ST-Segment Elevation Myocardial Infarction
9 Thrombolytic Therapy 237
10 Primary Angioplasty 281
11 Expanding the Access to Percutaneous Coronary Intervention for Patients Admitted to Community Hospitals 315
12 Antiplatelet and Anticoagulant Therapy 333
13 [beta]-Adrenergic Blockers, Calcium Channel Blockers, and Nitrates 377
14 Angiotensin Converting Enzyme Inhibitors After and During Acute Coronary Syndromes, and, in Particular, Myocardial Infarction 399
15 Risk Stratification: Exercise Testing, Imaging, and Cardiac Catheterization 425
Pt. IV Non-ST-Segment Elevation Myocardial Infarction
16 Anticoagulant Therapies 459
17 Antiplatelet Therapy 481
18 Thrombolytics and Invasive vs Conservative Strategies in Unstable Angina 519
19 Current Device Strategies in the Management of Acute Coronary Syndromes 535
Pt. V Special Aspects of Acute Coronary Syndromes
20 Women and Acute Coronary Syndromes 569
21 The Modern Strategy for Cardiogenic Shock 603
22 Myocardial Infarction in the Younger Patient 653
23 Cholesterol Lowering 667
24 "Secondary Prevention" of Myocardial Infarction 695
25 Cost and Cost-Effectiveness in Acute Coronary Syndromes 705
26 Smoking Cessation 725
27 Critical Pathways for Acute Coronary Syndromes 745
Index 763
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