ACUTE CORONARY SYNDROMES Edited by Mariano E. Brizzio Acute Coronary Syndromes Edited by Mariano E. Brizzio Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Molly Kaliman Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Acute Coronary Syndromes, Edited by Mariano E. Brizzio p. cm. 978-953-307-827-4 Contents Preface IX Chapter 1 Antiplatelet Therapy in Cardiovascular Disease – Past, Present and Future 1 Mariano E. Brizzio Chapter 2 Thrombotic Inception at Nano-Scale 7 Suryyani Deb and Anjan Kumar Dasgupta Chapter 3 Physiopathology of the Acute Coronary Syndromes 27 Iwao Emura Chapter 4 Evolution of Biochemical Diagnosis of Acute Coronary Syndrome – Impact Factor of High Sensitivity Cardiac Troponin Assays 45 Amparo Galán, Josep Lupón and Antoni Bayés-Genis Chapter 5 Pathogenesis of Acute Coronary Syndrome, from Plaque Formation to Plaque Rupture 65 Hamdan Righab, Caussin Christophe, Kadri Zena and Badaoui Georges Chapter 6 Plaque, Platelets, and Plug – The Pathogenesis of Acute Coronary Syndrome 77 Anggoro B. Hartopo, Budi Y. Setianto, Hariadi Hariawan, Lucia K. Dinarti, Nahar Taufiq, Erika Maharani, Irsad A. Arso, Hasanah Mumpuni, Putrika P.R. Gharini, Dyah W. Anggrahini and Bambang Irawan Chapter 7 Acute Coronary Syndrome Secondary to Acute Aortic Dissection – Underlying Mechanisms and Possible Therapeutic Options 99 Kazuhito Hirata, Tomoya Hiratsuji, Minoru Wake and Hidemitsu Mototake VI Contents Chapter 8 Atypical Presentation in Patients with Acute Coronary Syndrome 109 Hyun Kuk Kim and Myung Ho Jeong Chapter 9 Exercise Training for Patients After Coronary Artery Bypass Grafting Surgery 117 Ching Lan, Ssu-Yuan Chen and Jin-Shin Lai Chapter 10 Risk Evaluation of Perioperative Acute Coronary Syndromes and Other Cardiovascular Complications During Emergency High Risky Noncardiac Surgery 129 Maria Milanova and Mikhail Matveev Chapter 11 Early Evaluation of Cardiac Chest Pain – Beyond History and Electrocardiograph 163 Ghulam Naroo and Aysha Nazir Chapter 12 Coronary Bypass Grafting in Acute Coronary Syndrome: Operative Approaches and Secondary Prevention 171 Stephen J. Huddleston and Gregory Trachiotis Chapter 13 Markers of Endothelial Activation and Impaired Autonomic Function in Patients with Acute Coronary Syndromes – Potential Prognostic and Therapeutic Implication 179 Arman Postadzhiyan, Anna Tzontcheva and Bojidar Finkov Chapter 14 Acute Coronary Syndrome from Angioscopic Viewpoint 205 Yasunori Ueda Preface This book has been written with the intention of providing an up-to-the minute review of acute coronary syndromes. Atherosclerotic coronary disease is still a leading cause of death within developed countries and not surprisingly, is significantly rising in others. Over the past decade the treatment of these syndromes has changed dramatically. The introduction of novel therapies has impacted the outcomes and surviving rates in such a way that the medical community need to be up to date almost on a “daily bases”. It is hoped that this book will provide a timely update on acute coronary syndromes and prove to be an invaluable resource for practitioners seeking new and innovative ways to deliver the best possible care to their patients. Mariano E. Brizzio, MD Editor in Chief The Valley Heart and Vascular Institute, Ridgewood, New Jersey USA [...]... Levy-Toledano S, Legrand YJ, Rendu F Collagen-induced platelet activation mainly involves the protein kinase C pathway Biochem J 1990 Jun 1;268(2):325-31 22 Acute Coronary Syndromes Kottke-Marchant K Importance of platelets and platelet response in acute coronary syndromes. Cleve Clin J Med 2009 Apr;76 Suppl 1:S2-7 Koziara JM, Oh JJ, Akers WS, Ferraris SP, Mumper RJ Blood compatibility of cetyl alcohol/polysorbate-based... ticlopidine to clopidogrel after coronary stent placement? Curr Control Trials Cardiovasc Med 2000; 1(2): 83–87 Bennet CL, Davidson CJ, Raisch DW, et al Thrombotic Thombocytopenic purpura with ticlopidine in the setting of coronary artery stents and stroke prevention Arch Intern Med 1999;159:2524-2528 Wiviott S et al Prasugrel versus clopidogrel in patient with acute coronary syndromes N Engl J Med 2008;357:2001-2015... (Luthi et al., 2010) 14 Acute Coronary Syndromes Fig 6 Diverse applications in nanotechnology In most of the above mentioned cases (diagnosis, drug delivery or treatment) the primary entry route of nanoparticle is through circulation where they interact directly with blood cells Conversely exposure to unwanted nanoparticles (e.g gas phase exhaust from car or industry ) inhaled by human, that can penetrate... Nanoparticle effect to discriminate between responder and non-responder of antiplatelet drugs (e.g aspirin and clopidogrel) The important question that crops up here is whether in the platelet context it is the nanosurface conjugation or the nano-material that play the lead role It follows that by modulating 20 Acute Coronary Syndromes the nano-surface, one can tune the thrombotic level, the desirable level depending... is not approved in the USA 4 Other P2Y 12 antagonist Ticlopidine an anti-platelet drug in the thienopyridine family inhibits platelet aggregation by altering the function of platelet membranes by irreversibly blocking ADP receptors This 4 Acute Coronary Syndromes prevents the conformational change of glycoprotein IIb/IIIa which allows platelet binding to fibrinogen (13) It is used in patients in whom... Inhibition of platelet function by an aspirin-insensitive endothelial cell ADPase Thromboregulation by endothelial cells.J Clin Invest 1991 Nov;88(5):1690-6 Marcus AJ, Zucker-Franklin D, Safier LB, Ullman HL Studies on human platelet granules and membranes J Clin Invest 1966 Jan;45(1):14-28 Massberg S, Schulz C, Gawaz M Role of platelets in the pathophysiology of acute coronary syndrome.Semin Vasc Med 2003 May;3(2):147-62... blood stream after disruption of plaque, and SRA monocytes might differentiate into SRA+ cells in PB by stimulation of M-CSF contained in plaque content, and that increased SRA+ cells in PB might be a useful indication of disrupted, fissured or eroded plaque and coronary thrombus 26 Acute Coronary Syndromes Although several scavenger receptors, such as SRA, CD36, scavenger receptor-B1, CD68 and Lox-1... Conclusions Antiplatelet therapy plays a crucial role in the treatment of coronary patients The continuous introduction of new agents is geared to improve results in patient ongoing percutaneous coronary interventions However, the side effects of theses should be monitored closely In the end, the ideal management of patients with acute coronary syndrome should be to be a collaborative effort between cardiologist... aspirin was the first anti-platelet 2 Acute Coronary Syndromes agent used and proven to be effective to reduce the incidence of myocardial infarction and stroke in many high risk vascular patients (2).The recurrence of vascular events in patients treated with aspirin alone ranges between 10 – 20% within five years of the initial event (2-7) Aspirin is effective by blocking the synthesis of TXa2, a powerful... nature 6 References Aragam KG, Bhatt DL Antiplatelet therapy in acute coronary syndromes. J Cardiovasc Pharmacol Ther 2011 Mar;16(1):24-42 Epub 2010 Oct 5 Arnida, Malugin A, Ghandehari H Cellular uptake and toxicity of gold nanoparticles in prostate cancer cells: a comparative study of rods and spheres.J Appl Toxicol 2010 Apr;30(3):212-7 Ashby B, Daniel JL, Smith JB Mechanisms of platelet activation and . ACUTE CORONARY SYNDROMES Edited by Mariano E. Brizzio Acute Coronary Syndromes Edited by Mariano E. Brizzio Published by InTech Janeza Trdine 9, 51000 Rijeka,. cardiovascular events. However, in the last few decades many different agents were introduced to have a more effective antiplatelet action and improve treatment outcomes in coronary syndromes. In. new agents is geared to improve results in patient ongoing percutaneous coronary interventions. However, the side effects of theses should be monitored closely. In the end, the ideal management