TY - JOUR
T1 - Time-honored treatments for the initial management of acute coronary syndromes
T2 - Challenging the status quo
AU - McCarthy, Cian P.
AU - Donnellan, Eoin
AU - Wasfy, Jason H.
AU - Bhatt, Deepak L.
AU - McEvoy, John W.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/10
Y1 - 2017/10
N2 - Morphine, oxygen, and nitrates are time-honored therapies for the initial management of acute coronary syndrome (ACS). The traditional goal of these agents in ACS has been to (1) relieve symptoms, (2) prevent infarction or limit its size, and (3) improve outcomes, both acutely and during follow-up. Despite their ongoing use in routine ACS care, nitrates, morphine, and oxygen have no evidence of clinical outcomes benefit from randomized trials. Furthermore, emerging data have recently suggested that, in certain situations, morphine and oxygen may actually be associated with harm in the setting of ACS. In this review article, we thoroughly examine updated evidence for each of these acute-phase ACS agents with respect to their individual risks and benefits. We review guideline recommendations for these therapies and outline future directions for their use in clinical practice.
AB - Morphine, oxygen, and nitrates are time-honored therapies for the initial management of acute coronary syndrome (ACS). The traditional goal of these agents in ACS has been to (1) relieve symptoms, (2) prevent infarction or limit its size, and (3) improve outcomes, both acutely and during follow-up. Despite their ongoing use in routine ACS care, nitrates, morphine, and oxygen have no evidence of clinical outcomes benefit from randomized trials. Furthermore, emerging data have recently suggested that, in certain situations, morphine and oxygen may actually be associated with harm in the setting of ACS. In this review article, we thoroughly examine updated evidence for each of these acute-phase ACS agents with respect to their individual risks and benefits. We review guideline recommendations for these therapies and outline future directions for their use in clinical practice.
KW - Morphine
KW - Nitrates
KW - Oxygen
UR - https://www.scopus.com/pages/publications/85020446127
U2 - 10.1016/j.tcm.2017.05.001
DO - 10.1016/j.tcm.2017.05.001
M3 - Review article
C2 - 28600103
AN - SCOPUS:85020446127
SN - 1050-1738
VL - 27
SP - 483
EP - 491
JO - Trends in Cardiovascular Medicine
JF - Trends in Cardiovascular Medicine
IS - 7
ER -
