Journal of Rare Cardiovascular Diseases

ISSN: 2299-3711 (Print) | e-ISSN: 2300-5505 (Online)

Advances in understanding and managing acute coronary syndrome: Pathophysiology, diagnostic innovations, and therapeutic strategies

Maroof Sabti Juma Al-Ammash1, Sajida Hussein Ismael2, Sarah Abdulateef Kadhim3, Baydaa Abd4, Mohammed Jawad Alnajar5, Mustafa Razzaq Flayyih6, Saja Tawfeeq Jassim7, Sultana Essa Mohamed Abobaker8
1Department of Pathological Analysis, Faculty of Applied Sciences, University of Basra, Basrah, Iraq
2College of Pharmacy, Al-Turath University, Baghdad, Iraq
3College of Health and Medical Techniques, Al- Bayan University, Baghdad, Iraq
4Al-Manara College for Medical Sciences, Amarah, Iraq
5Al-Nisour University College, Nisour Seq. Karkh, Baghdad, Iraq
6Mazaya University College, Iraq
7Department of Medical Laboratory Technology, College of Medical Technology, Al-Farahidi University, Baghdad, Iraq
8College of Science, Sebha University, Sabha, Libya
Maroof Sabti Juma Al-Ammash1, Sajida Hussein Ismael2, Sarah Abdulateef Kadhim3, Baydaa Abd4, Mohammed Jawad Alnajar5, Mustafa Razzaq Flayyih6, Saja Tawfeeq Jassim7, Sultana Essa Mohamed Abobaker8
1Department of Pathological Analysis, Faculty of Applied Sciences, University of Basra, Basrah, Iraq
2College of Pharmacy, Al-Turath University, Baghdad, Iraq
3College of Health and Medical Techniques, Al- Bayan University, Baghdad, Iraq
4Al-Manara College for Medical Sciences, Amarah, Iraq
5Al-Nisour University College, Nisour Seq. Karkh, Baghdad, Iraq
6Mazaya University College, Iraq
7Department of Medical Laboratory Technology, College of Medical Technology, Al-Farahidi University, Baghdad, Iraq
8College of Science, Sebha University, Sabha, Libya
Corresponding Email: sarah.a@albayan.edu.iq
  • Received 10/06/2024
  • Revised 01/07/2024
  • Accepted 15/11/2024
  • Published 24/02/2025

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Abstract

Acute Coronary Syndrome (ACS) encompasses unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), which arise from acute myocardial ischemia due to coronary artery obstruction. ACS is a leading cause of global morbidity and mortality, requiring prompt diagnosis and intervention. Pathophysiology involves plaque rupture, thrombosis, and ischemic injury, exacerbated by systemic inflammation and oxidative stress. Diagnosis is guided by clinical symptoms, electrocardiography (ECG), and biomarkers like high-sensitivity troponins, complemented by imaging tools such as echocardiography and coronary computed tomography angiography (CCTA). Treatment aims to restore perfusion, reduce myocardial damage, and prevent recurrence. STEMI necessitates immediate reperfusion via primary percutaneous coronary intervention (PCI) or fibrinolysis, while NSTEMI and UA management depends on risk stratification using tools like GRACE or TIMI scores. Dual antiplatelet therapy (DAPT), anticoagulants, beta-blockers, statins, and ACE inhibitors form the cornerstone of pharmacological treatment. Recent advancements include newer antiplatelet agents (ticagrelor, prasugrel), lipid-lowering therapies (PCSK9 inhibitors), and hybrid approaches combining PCI and coronary artery bypass grafting (CABG). Challenges persist in timely diagnosis, access to advanced care, and addressing disparities in outcomes. Multidisciplinary care and cardiac rehabilitation are critical for improving long-term prognosis. Emerging technologies, including digital health and AI-driven tools, hold promise for enhancing ACS management. In summary, a comprehensive, evidence-based approach is essential for managing ACS effectively, with ongoing innovation and global efforts aimed at improving equity, access, and personalized care.

key word
acute coronary syndrome, unstable angina, NSTEMI, STEMI, myocardial infarction, revascularization, risk stratification, multidisciplinary care, pharmacological advances

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Classification of Rare Cardiovascular Diseases anticoagulation atrial fibrillation atrial septal defect cardiac tumor cardiomyopathy computed tomography congenital heart disease echocardiography electrocardiogram electrocardiography heart failure implantable cardioverter‑defibrillator magnetic resonance imaging pregnancy pulmonary arterial hypertension pulmonary hypertension rare cardiovascular disease rare disease right heart catheterization right ventricular failure
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