Risk Factors and Management of Acute Coronary Syndrome

Major Risk Factors for ACS

Smoking is a major contributor to ACS development, associated with higher rates of STEMI compared to other ACS types, and is a significant risk factor for adverse outcomes in a 50-year-old patient, according to the American College of Cardiology 3, 4
Hypertension is strongly associated with increased risk of poor outcomes in ACS patients, contributing to greater extent of underlying CAD and left ventricular dysfunction, as stated by the American College of Cardiology 3, 4, 1
Age, specifically being 50 years old, remains an independent risk factor for ACS, as noted by the American Heart Association 5, 3

Smoking causes endothelial dysfunction, promotes atherosclerosis, increases platelet aggregation, and induces coronary vasospasm, as reported by the American College of Cardiology 3, 4
Hypertension accelerates atherosclerosis, causes vascular remodeling, and contributes to left ventricular hypertrophy, according to the American College of Cardiology 3, 4

Immediate 12-lead ECG must be performed within 10 minutes of arrival at emergency facility, as recommended by the American Heart Association 1, 2
Serial ECGs should be performed at 15-30 minute intervals during the first hour in symptomatic patients with initial nondiagnostic ECG, as suggested by the American Heart Association 1, 2
Cardiac troponin measurement is required in all patients with symptoms consistent with ACS, with serial measurements at presentation and 3-6 hours after symptom onset, as stated by the American College of Cardiology 1, 2
Risk stratification should use validated risk scores such as TIMI or GRACE to guide management decisions, as recommended by the American Heart Association 1, 2, 6

Antiplatelet therapy should be initiated with aspirin and a P2Y12 inhibitor like clopidogrel, as recommended by the American College of Cardiology 1, 2
Anticoagulation should be considered based on risk stratification, as suggested by the American College of Cardiology 1, 2

Smoking cessation is critical for reducing recurrent events and mortality, as stated by the American Heart Association 1
Hypertension control should target blood pressure <130/80 mmHg with appropriate antihypertensive medications, as recommended by the American College of Cardiology 1
Statin therapy is indicated regardless of baseline lipid levels, as suggested by the American College of Cardiology 1
Beta-blocker therapy is recommended for most ACS patients without contraindications, as stated by the American College of Cardiology 1

Cocaine and methamphetamine screening should be considered in younger patients with suspected substance abuse, as reported by the American College of Cardiology 3, 4, 1
The "smoker's paradox" is associated with lower short-term mortality in ACS, but should not diminish aggressive smoking cessation efforts, as noted by the American College of Cardiology 3, 4