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High-risk non-ST elevation acute coronary syndromes (NSTEACS) for paramedics

06 August 2012
Volume 4 · Issue 8


Pre-hospital clinicians frequently encounter patients suffering acute coronary syndromes (ACS) and they form an integral part in recognising and conveying the ST-elevation myocardial infraction (STEMI) patient to the most appropriate destination, namely the heart attack centre (HAC). The emphasis has been upon the recognition and subsequent management of the STEMI patient. The non-ST elevation acute coronary syndrome (NSTEACS) patient has a similar mortality and morbidity yet does not receive the same pathways as STEMI. This article aims to provide an understanding based on a case study around NSTEACS with supporting evidence relating to risk stratification, clinical trials and clinical guidelines of what needs to be developed to enhance the care we provide to the NSTEAC patient in the pre-hospital arena.

Ischaemic heart disease (IHD) is the leading cause of death worldwide with 12.8% of all deaths attributed to this (World Health Organization (WHO), 2011). A number of IHD patients may also develop an acute coronary syndrome (ACS). Ambulance clinicians commonly encounter patients suffering ACS, this being unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).

Differentiating between the three can be challenging, however with good history from the patient, including history of the complaint along with established cardiac risk factors, familial history and a good understanding of electrocardiograms (ECGs), differentiating between STEMI and Non ST elevation acute coronary syndromes (NSTEACS) can be clinically suspected and achieved with blood biomarker assays.However, all three types of ACS would warrant the same drug therapy from paramedics and currently only STEMI patients attend heart attack centres (HACs) as standard practice where the patients may undergo primary percutaneous coronary intervention (pPCI). These patients undergo an assessment by a cardiologist and angiography commonly followed by re-vascularisation and stent insertion if required to open up the affected coronary artery/s. NSTEACS patients could be seen to be pre-STEMI as their stenosis may be critical and may develop into a STEMI, therefore benefiting from early expert opinion to optimise future heart function and if required revascularisation.

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