Coronary Artery Disease

What is Acute Coronary Syndrome?

Acute Coronary Syndrome (ACS) is a situation of medical emergency that refers to a group of clinical conditions compatible with acute myocardial ischemia (AMI) and/or infarction. ACS occurs when the blood supply to the heart is blocked due to destabilization of a previously stable atherosclerotic plaque.^2,3

There are three classifications according to the presence of Electrocardiography (ECG) abnormalities and Myocardial Infarction (MI):^2,3

• Unstable angina;
• NSTEMI (non ST-segment-elevation MI);
• STEMI (ST-segment-elevation MI).^2,3

How is AMI diagnosed?

Myocardial infarction (MI), commonly known as a heart attack, is defined pathologically as the irreversible death of myocardial cells caused by ischemia. Clinically, MI is a syndrome that can be recognized by a set of symptoms, chest pain being the hallmark of these symptoms in most cases, supported by biochemical laboratory changes, electrocardiographic (ECG) changes, or findings on imaging modalities able to detect myocardial injury and necrosis.

The Fourth Universal Definition of Myocardial infarction proposes that the term acute myocardial infarction(AMI) should be used only when there is acute myocardial damage with clinical evidence of acute myocardial ischemia.⁴

The diagnosis of AMI requires elevation or drop in troponin values and the presence of at least one of the following criteria:

1. Symptoms of acute myocardial ischemia;
2. New ischemic electrocardiographic (EKG) findings;
3. Development of new abnormal Q waves;
4. Imaging evidence of loss of viable myocardium or abnormal motion of any of the walls due to ischemic cause; or
5. Identification of a coronary thrombus on angiography.

Should this not be the case, then the proposal is to refer only to myocardial damage.⁴ High-sensitivity (hs)–cTn assays are recommended for routine clinical use.⁵ Myocardial injury is defined as being present when blood levels of cTn are increased above the 99th percentile upper reference limit (URL).^5,6 The injury may be acute, as evidenced by a newly detected dynamic rising and/or falling pattern of cTn values above the 99th percentile URL, or chronic, in the setting of persistently elevated cTn levels.

Partner with the pioneer to improve AMI diagnosis

Through a combination of technical improvements and supporting the right clinical studies Roche has improved the way AMI is diagnosed around the world. This has led to the ability to triage over 75% of ED chest pain patients in as little as 1 hour.

A rapid and accurate diagnosis is critical when patients arrive with acute chest pain and suspected heart attack are in the emergency department. The TRAPID-AMI study⁷ results show that the cardiac Troponin T-high sensitive test from Roche provides a reliable and rapid diagnosis within a 1-hour, and much faster than the 3 to 6 hours observation time using the conventional diagnostic approach.

There are significant benefits to this approach, including:

• Improved care
• Shorter length of stay in ED
• Substantial cost savings
• ESC Guidelines compliance

Troponin is the preferred biomarker in defining AMI according to the European Society of Cardiology (ESC) guidelines.⁸ In addition, it is the gold standard to distinguish between AMI and non-AMI patients.^8,9

Elecsys® Troponin T-high sensitive (TnT-hs) can reduce the time needed to rule-in or rule-out NSTEMI to as little as just 1 hour.^10-12