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Please note – the Post-MI Knowledge Centre is for doctors and other healthcare professionals.

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Acute coronary syndrome (ACS) is a broad term that includes the diagnoses of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).¹ UA and NSTEMI are sometimes referred to collectively as non-ST-segment elevation ACS (NSTE-ACS).²

Regardless of the specific clinical presentation, all cases of ACS result from myocardial ischaemia, usually due to the formation of an occlusive thrombus in a coronary artery following the rupture or erosion of an atherosclerotic lesion.²

Prolonged, severe interruption of the blood flow to the myocardium (15-30 minutes) leads to necrosis, which is the pathological definition of myocardial infarction.^3,4 Complications include heart failure, conduction disturbances, arrhythmias and mitral valve regurgitation.¹

The classic symptom of ACS is chest pain, which is frequently described as retrosternal pressure or heaviness, and may radiate to the jaw, neck or arms.² Other symptoms include diaphoresis, nausea, dyspnoea, abdominal pain and syncope.²

Diagnosis and differential diagnosis is based on a combination of clinical examination, electrocardiography (ECG) and tests for cardiac enzymes (troponins) in the blood.²

Although in-hospital mortality among patients presenting with ACS has declined considerably in recent decades, the risk of dying before reaching hospital has remained relatively unchanged.⁴ Recurrent MI, heart failure and cardiogenic shock are important causes of morbidity and mortality in the ACS population, both during hospitalisation and after discharge.⁵

Following MI, a range of pharmacological and non-pharmacological interventions have been shown to reduce morbidity and mortality from cardiovascular causes.⁴ Antiplatelet agents, beta-blockers, ACE inhibitors and HMG-CoA reductase inhibitors (statins) all have a central role in post-MI care.

Non-pharmacological interventions include implantation of a defibrillator (or cardiac synchronisation device) but also diet and lifestyle modifications, such as smoking cessation and regular exercise.⁴