ACUTE CORONARY SYNDROME: EARLY DIAGNOSIS AND THERAPEUTIC MANAGEMENT IN EMERGENCY DEPARTMENT
DOI:
https://doi.org/10.56238/levv17n57-046Keywords:
Acute Coronary Syndrome, Early Diagnosis, Emergency Medicine, Myocardial Infarction, TherapeuticsAbstract
Cardiovascular diseases remain the leading cause of global morbidity and mortality, and acute coronary syndrome (ACS) represents a major challenge in urgent and emergency care services. This narrative review synthesizes evidence published between 2021 and 2025 on the early diagnosis and management of ACS in emergency settings. Contemporary diagnosis is based on the integration of clinical assessment, a 12-lead electrocardiogram, and high-sensitivity cardiac biomarkers, especially troponin. The adoption of accelerated diagnostic algorithms (0/1 h and 0/2 h) has increased the efficiency and safety of clinical workflows, allowing reliable exclusion of acute myocardial infarction in low-risk patients when applied in conjunction with clinical judgment. Risk stratification is improved through validated scores, particularly the HEART score for short-term mortality prediction and the T-MACS score for identifying patients at higher risk of major adverse cardiovascular events. In ACS without persistent ST-segment elevation, the timing of coronary angiography is determined by the ischemic risk profile, with immediate invasive strategy recommended for very high-risk patients and early invasive approach for high-risk individuals. Initial therapeutic management includes antiplatelet therapy and anticoagulation, balancing ischemic benefit and bleeding risk. Challenges persist due to the heterogeneity of clinical presentations and disparities in care, especially among women and older adults. Overall, recent advances support a care model increasingly guided by risk stratification, standardized protocols, and technological integration.
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References
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