Treatment Principles for Non-ST Elevation Myocardial Infarction

Non-ST elevation myocardial infarction (NSTEMI) requires a comprehensive treatment approach aimed at preventing further cardiac damage and improving long-term outcomes. Key strategies include dual antiplatelet therapy, anticoagulation, lipid-lowering treatment, anti-ischemic therapy, and timely reperfusion. These interventions are designed to reduce clot formation, stabilize atherosclerotic plaques, and restore blood flow to the heart muscle. Below is a detailed overview of the main treatment principles:

Dual Antiplatelet Therapy

Strong antiplatelet treatment is crucial in managing NSTEMI, as platelet aggregation plays a central role in the formation of coronary thrombi. Patients are typically prescribed dual antiplatelet therapy combining aspirin and ticagrelor. This combination helps prevent further clot development and reduces the risk of subsequent cardiovascular events.

Anticoagulation Therapy

During the acute phase of a heart attack, anticoagulation is essential to prevent clot extension and new thrombus formation. Low molecular weight heparin (LMWH) is commonly used alongside antiplatelet drugs to enhance antithrombotic effects. This combined approach supports better blood flow and reduces the risk of complications.

Intensive Lipid-Lowering Treatment

Cholesterol management is a cornerstone of long-term care in NSTEMI patients. Low-density lipoprotein cholesterol (LDL-C) contributes significantly to plaque formation and rupture in coronary arteries. To stabilize existing plaques and prevent disease progression, high-intensity statin therapy is recommended. In certain cases, additional agents such as ezetimibe or PCSK9 inhibitors may be added for more aggressive cholesterol reduction.

Beta-Blockers and Nitrate Therapy

To manage ischemia and reduce the heart's workload, anti-ischemic medications are often prescribed. Beta-blockers like metoprolol succinate help lower heart rate and blood pressure, while nitrate-based drugs such as nitroglycerin improve blood flow by dilating coronary arteries. Another drug, nicorandil, also aids in relieving ischemia by enhancing coronary circulation.

Early Reperfusion Strategy

Unlike ST-elevation myocardial infarction (STEMI), NSTEMI does not always require immediate reperfusion. However, current guidelines emphasize the importance of early revascularization for high-risk patients. While emergency percutaneous coronary intervention (PCI) or thrombolytic therapy may not always be necessary, timely coronary angiography followed by stent placement is recommended when feasible. Restoring blood flow as soon as possible can significantly improve myocardial function and patient prognosis.