Syndrome ACS )

(Acute Coronary

90

rupture)

(atheromatous plaque

1. Unstable angina (UA)

elevation

(Electrocardiogram - ECG)

ST segment depression

ST segment

T wave inversion

cardiac

biomarkers (negative)
2. Non-ST-Elevation myocardial infarction (Non Q-wave MI

depression

T wave inversion

ST segment elevation

NSTEMI)

ST

cardiac biomarkers positive

Q wave

3. ST- Elevation MI (STEMI)

ST segment elevation

cardiac biomarkers positive

 (Acute myocardial infarction

AMI

Acute coronary syndrome

ACS)

Heart Attack

..2553

7.2

12.2 %

37,000

Acute MI

Acute MI

25

(1)

..2548-2552

death (SCD)

470

1,185

Sudden cardiac

48-63%

45%

80%

15%

SCD

5%

50%

63%

Syndrome Registry (TACSR

4-6

Thai Acute Coronary

1)



.. 2550 (2)
.. 2545

3,973

Unstable Angina 21.2%

17%

7-10%

17

31

2548

STEMI 40.9%

NSTEMI 34.9%
STEMI

STEMI

GRACE (3)
(16.3%

TACSR (2)

7%)

AMI

intervention

PPCI)

(Primary percutaneous coronary

12

STEMI

(Thai Registry of ACS II)

30.4%

Primary PCI 22.2%

(Development of atherosclerosis)

macrophage

1 Fatty streak

2 Fibrous plaque

premature infant

Mature plaque

smooth muscle cell, macrophage

plaque

fibrous plaque

white blood cell, calcium

3 Ruptured plaque

fatty streak

fibrinogen

collagen

smooth

fibrin, fibrinogen, albumin,

lipoprotein

complicated plaque

llb/llla)

form cell

extracellular lipid core

muscle cells

smooth muscle cells

(intima)

plaque

glycoprotein llb/llla receptor (GP

UA, NSTEMI

STEMI

fibrinolysis

(plaque rupture)

thrombus

hypercoagulability

1.

2.

plaques

plaque

fibrous cap

foam cell, macrophage

vulnerable plaques

subendothelium

plaques

plaques

fibrous cap

foam cell

subendothelium

1.

140/90

2.







Cholesterol

(
)

LDL-C

( ) (

( ) ( )

HDL-C

LDL-C

HDL-C

( Triglycerides)

HDL-C

HDL-C

Cholesterol

Cholesterol

3.

20

(sudden death)

(nicoti)

4.

5.

22.9

(body mass index / BMI)

6.

80

90

10-30

HDL

30

3-4

7.

40

4 -20

8.

norepinephrine

serum lipid

epinephrine

lipid metabolism

1.

2.

ACS

Acute Coronary Syndrome

lipidladen plaque

thin cap

plaque

subendothelium

plaque

1. Plaque rupture

plaque

plaque



coagulation system

fibrinogen cross-link platelet

2. Unstable plaque

thrombin

3. Microemboli
distal thrombin

microemboli

cardiac troponin

(non-ST elevated MI)

4. Occlusive thrombus

thrombin

Q wave MI

sudden cardiac death

Acute myocardial infarction

1.

2.

Coronary Intervention (PCI))

( Pharmacologic therapy )
(Percutaneous

3.

(Coronary artery bypass graft

(CABG))

( Pharmacologic therapy )

1. Anti-ischemic drugs

- Nitrates

Isosorbride dinitrate,ISDN, Nitroglycerine,

Isosorbride 5- Mononitrate
- Beta-blocker

Atenolol, Propanolol, Metropolol, Bisoprolol,

Carvidiol,

- Calcium-blockers

Amlodipine, Felodipine, Nifidipine,

Diltiazem, Verapamil
2. Antiplatelets

3. Anticoagulants

Aspirin Ticlopidine, Clopidogrel

Unfractionated heparin, Low-molecular weight

heparin (LMWH) , Glycoprotein (GP) IIB/IIIa inhibitors

(Percutaneous

Coronary Intervention : PCI)

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Percutaneous Transluminal Coronary Intervention (PCI)

CABG)

(Coronary artery bypass graft :