Stakeholder Insight: Acute Coronary Syndromes Fresh look at ACS in Europe, what is the real picture
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the cardiovascular analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the ACS market - page 4
- Contributing experts - page 5
- CHAPTER 2 ACS DEFINITIONS AND PATHOPHYSIOLOGY - page 7
- Acute coronary syndromes - page 7
- Definitions - page 7
- Pathophysiology - page 8
- Coronary artery disease and atherosclerosis - page 8
- Vulnerable plaque - page 9
- Histopathology of atherosclerotic lesions - page 10
- Remodeling and role of coronary artery inflammation - page 12
- Thrombosis - page 13
- Atherosclerotic calcification - page 14
- Ischemia - page 14
- Unstable angina (UA) - page 15
- Variant angina - page 17
- Non-ST segment elevated myocardial infarction (NSTEMI) - page 17
- Non-ST segment elevated myocardial infarction (NSTEMI) and ST segment elevated myocardial infarction (STEMI) - page 18
- New definition of myocardial infarction - page 18
- Acute coronary syndromes - page 7
- CHAPTER 3 EPIDEMIOLOGY - page 19
- ACS epidemiology specifics and limitations - page 19
- Ageing population - page 21
- Male to female ratio and age - page 22
- Risk factors - page 23
- Smoking - page 24
- Obesity and overweight prevalence - page 24
- Diabetes - page 30
- Hypertension - page 32
- Dyslipidemia - page 34
- Prevalence and incidence of ACS in the 5EU - page 36
- Incidence of STEMI - page 36
- Incidence of UA and NSTEMI - page 36
- ACS epidemiology specifics and limitations - page 19
- CHAPTER 4 DIAGNOSIS AND INVESTIGATION IN ACS - page 38
- Symptoms - page 38
- Initial and final diagnosis - page 38
- Physical examination and chest pain differential - page 40
- Clinical tests in primary investigation - page 41
- ECG and ECG Stress testing - page 41
- Cardiac biomarkers - page 42
- Cardiac troponins - page 42
- Creatine Kinase (CK) - page 43
- Myoglobin - page 44
- C-reactive protein (CRP) - page 44
- Neurohormonal activation markers - page 44
- Novel biomarkers - page 45
- Multimarker approach - page 45
- Risk stratification - page 46
- Role of imaging tests in ACS - page 47
- Invasive imaging testing - page 47
- Coronary angiography - page 48
- Intravascular ultrasound (IVUS) - page 49
- Intravascular MRI (IVMRI) - page 50
- Non-invasive imaging testing - page 51
- Echocardiography and stress echo - page 51
- Chest X-ray - page 54
- Nuclear perfusion tests - page 54
- Role of MRI and CT in coronary heart disease diagnosis - page 55
- Limitations of early imaging in the emergency department - page 57
- Invasive imaging testing - page 47
- Symptoms - page 38
- CHAPTER 5 PHARMACOLOGICAL STRATEGIES - page 58
- Drug classes in ACS - page 58
- Anti-ischemic agents - page 58
- Nitrates - page 58
- Betablockers - page 59
- Calcium channel blockers - page 60
- ACE inhibitors and angiotensin II receptor blockers - page 61
- Antithrombotics - page 62
- Anticoagulants - page 62
- Heparins - page 62
- Antiplatelet agents - page 65
- COX-1 inhibitors (aspirin) - page 65
- ADP receptor antagonists - page 66
- GPIIb/IIIa receptor inhibitors - page 68
- Thrombolytics - page 70
- Fibrinolysis - page 70
- Pharmacological reperfusion - page 70
- Statins - page 72
- Anti-ischemic agents - page 58
- Drug classes in ACS - page 58
- CHAPTER 6 REVASCULARIZATION STRATEGIES - page 73
- Coronary thrombolysis - page 73
- Pre-hospital thrombolysis - page 73
- In-hospital thrombolysis - page 74
- Contraindications to fibrinolytic therapy - page 75
- Interventions versus thrombolysis - page 76
- Clinical trial evidence: C-PORT and a meta-analysis - page 76
- Evidence from registries - page 77
- Angioplasty - page 78
- Stenting - page 80
- In-stent restenosis: the man-made condition - page 81
- Drug-eluting stents - page 81
- ESC guidelines on PCI strategy in NSTE-ACS and STEMI - page 82
- Stenting - page 80
- Coronary artery bypass graft (CABG) - page 84
- Coronary thrombolysis - page 73
- CHAPTER 7 HOSPITAL INFRASTRUCTURE AND PATIENT FLOW - page 85
- Overview - page 85
- General practitioners and outpatient facilities - page 85
- Role of ambulance services - page 86
- Emergency department (ED) - page 87
- Coronary care and intensive care unit - page 87
- Cardiac catheterization laboratory (Cathlab) - page 88
- Overview - page 85
- CHAPTER 8 REVIEW OF CURRENT GUIDELINES - page 89
- ESC guidelines - page 89
- Recommendations by the ESC - page 89
- Guidelines for STEMI patients - page 89
- ESC guidelines - page 89
- CHAPTER 9 KEY FIGURES AND STATISTICAL ANALYSIS - page 93
- Methodology - page 93
- Patient demographics - page 94
- Main diagnosis - page 94
- ACS age and sex distributions - page 96
- Co-morbidities and risk factors - page 103
- Diabetes - page 103
- Dyslipidemia - page 104
- Hypertension - page 105
- Obesity - page 106
- Smoking - page 107
- ACS hospital logistics - page 109
- Mode of admission - page 109
- Mode of admission for patients with ST-segment elevation - page 111
- Type of hospital for ACS patient admission. - page 112
- The importance of cathlabs - page 113
- Point of entry to hospital - page 114
- First stage - page 114
- Second stage - page 116
- Length of stay in hospital - page 118
- Hospital transfers - page 120
- Mode of admission - page 109
- Diagnostic procedures - page 122
- Cardiac biomarkers - page 122
- Non-invasive imaging test - page 124
- Reperfusion therapy - page 129
- Thrombolytic therapy - page 129
- Coronary interventions - page 133
- Pharmacological therapy - page 137
- Anticoagulants - page 137
- Unfractionated heparins - page 137
- Low molecular weight heparins - page 138
- Antiplatelet agents - page 140
- COX-1 inhibitors - page 140
- ADP receptor antagonists - page 141
- GPIIb/IIIa receptor inhibitors - page 142
- Anti-ischemic agents - page 144
- Nitrates - page 144
- Betablockers - page 146
- ACE inhibitors - page 148
- Anticoagulants - page 137
- Summary - page 149
- APPENDIX - page 152
- References - page 152
- General sources - page 152
- Obesity Epidemiology sources - page 154
- France - page 154
- Germany - page 154
- Italy - page 154
- Spain - page 154
- UK - page 155
- About Datamonitor - page 155
- About Datamonitor Healthcare - page 155
- About the Cardiovascular Disease analysis team - page 156
- Disclaimer - page 157
- References - page 152
- List of Tables
- Table 1: Prevalence of obesity in the seven major markets (000s), 2006-2015 - page 26
- Table 2: Prevalence of obesity / overweight in the seven major markets (000s), 2006-2015 - page 27
- Table 3: Estimated absolute prevalence of diabetes in the seven major markets (millions), 2006 - page 31
- Table 4: Prevalence of hypertension in the seven major markets (000s), 2003 - page 34
- Table 5: Estimated prevalent persons with dyslipidemia across the seven major markets, 2005 - page 35
- Table 6: Incidence of ST-segment elevation myocardial infarction (000s) - page 36
- Table 7: Incidence of unstable angina and non-ST segment elevation myocardial infarction (000s) - page 37
- Table 8: Types of chest pain - page 40
- Table 9: Risk stratification summary for ACS, 2006 - page 47
- Table 10: Number of PCI procedures performed in the 5EU, 2005 - page 80
- Table 11: CABG procedures performed in the 5EU, 2005 - page 84
- Table 12: ESC guidelines for the management of STEMI, 2002 - page 90
- List of Figures
- Figure 1: Development and progression of atherosclerosis - page 8
- Figure 2: Pathogenesis of a plaque leading to rupture - page 10
- Figure 3: ACS pathophysiology cycle - page 13
- Figure 4: The 10 leading causes of death in high-income countries (%),2005 projections - page 19
- Figure 5: Deaths attributed to specific cardiovascular diseases, 2006 - page 20
- Figure 6: Major causes of death in the 5EU, 2006 - page 21
- Figure 7: Distribution of the population in Europe by age, 2004 - page 22
- Figure 8: Distribution of the population in Europe by age, 2050 - page 23
- Figure 9: Basic diagnostic flow in ACS - page 39
- Figure 10: Antiplatelet therapy in ACS - page 69
- Figure 11: Ancrod acts indirectly on the thrombolytic pathways - page 71
- Figure 12: Contraindications to fibrinolytic therapy - page 76
- Figure 13: PCI procedures carried out by indication in the 5EU, 2005 - page 79
- Figure 14: Management of ACS without ST-elevation (NSTE-ACS) - page 83
- Figure 15: Management of ACS in STEMI - page 83
- Figure 16: Typical patient flow in case of acute chest pain - page 86
- Figure 17: Delays in patients with acute chest pain - page 88
- Figure 18: Proportion of patients presented with and without ST-segment elevation on initial ECG, 5EU, 2007 - page 94
- Figure 19: Ratio of main ACS diagnoses in 5EU - page 95
- Figure 20: Overall ACS age distribution in the ACV analyzer sample - page 96
- Figure 21: ACS age distribution split by country and sex - page 97
- Figure 22: Changes in main diagnosis ratio in age distribution - page 99
- Figure 23: Changes in main diagnosis ratio by age and sex, MALE - page 100
- Figure 24: Changes in main diagnosis ratio by age and sex, FEMALE - page 100
- Figure 25: Age-related variations in male:female ratio of ACS patients in the 5EU - page 101
- Figure 26: Diabetes distribution among ACS patients in the 5EU - page 103
- Figure 27: Dyslipidemia distribution among ACS patients in the 5EU - page 104
- Figure 28: Hypertension distribution among ACS patients in the 5EU - page 105
- Figure 29: BMI distribution among ACS patients in the 5EU - page 106
- Figure 30: Percentage of patients who smoke in the ACS analyzer sample per country - page 107
- Figure 31: Hospital admission mode for ACS patients - page 109
- Figure 32: Mode of hospital admission for patients with ST-segment elevation - page 111
- Figure 33: Patients admitted via ambulance to hospitals with or without cathlabs - all patients versus those with ST-segment elevation - page 112
- Figure 34: Proportion of ACS patients admitted to hospitals with or without cathlab by all modes of admission - all patients versus those with ST-segment elevation - page 113
- Figure 35: First stop in hospital after admission - all patients versus those with ST-segment elevation - page 114
- Figure 36: Second stop in hospital after admission - all patients versus those with ST-segment elevation - page 117
- Figure 37: Diagnostic challenge: Second stop in hospital after admission for patients without ST-segment elevation and with negative troponin - page 118
- Figure 38: Length of in-hospital stay for ACS patients, UA - page 119
- Figure 39: Length of in-hospital stay for ACS patients, NSTEMI - page 119
- Figure 40: Length of in-hospital stay for ACS patients, STEMI - page 120
- Figure 41: Percentage of all ACS patients who have been transferred or referred to hospitals and transferred from hospitals for further PCI or CABG or other treatment - page 121
- Figure 42: Distribution of troponin test - page 122
- Figure 43: Distribution of Echo and Nuclear perfusion tests - page 124
- Figure 44: Distribution of CT and MRI tests - page 126
- Figure 45: Distribution of stress test - page 127
- Figure 46: Distribution of IVUS (%) in angiography cases only - page 128
- Figure 47: Distribution of thrombolytic therapy in all ACS patients and in patients presented with ST-segment elevation - page 129
- Figure 48: Country distribution of thrombolytic therapy in patients presented with ST-segment elevation only - page 130
- Figure 49: Country distribution of success rate of thrombolytic therapy in patients presented with ST-segment elevation - page 131
- Figure 50: Specific thrombolytic molecules use distribution in 5 European countries - page 132
- Figure 51: % of all ACS patients receiving Diagnostic Angiography test then PCI and then Stenting - page 133
- Figure 52: Door to PCI time, percentage of patients who received PCI <12h from hospital admission vs. >12h from hospital admission - page 134
- Figure 53: Distribution of STENT implantations by type - page 135
- Figure 54: % of CABG - page 135
- Figure 55: Early reperfusion therapy (< 12 h after onset of symptoms) distribution in STEMI patients - page 136
- Figure 56: Use of unfractionated heparins in the treatment of ACS patients - page 137
- Figure 57: Use of low molecular weight heparins (LMWH) in the treatment of ACS patients - page 139
- Figure 58: Use of COX-1 Inhibitors (aspirin) in the treatment of ACS patients - page 140
- Figure 59: Use of ADP receptor antagonists in the treatment of ACS patients - page 141
- Figure 60: Use of GPIIb/IIIa receptor inhibitors in the treatment of ACS patients - page 143
- Figure 61: Use of nitrates in the treatment of ACS patients - page 144
- Figure 62: Use of betablockers in the treatment of ACS patients - page 146
- Figure 63: Use of ACE inhibitors in the treatment of ACS patients - page 148
Other users found this report page using the following search terms: Acute Coronary Syndromes reperfusion therapy PCI percutaneous coronary intervention myocardial infarction thrombolysis coronary acute acs syndrome prevalence incidence europe stemi syndromes uk
If you can't find a report that meets your needs contact LeadDiscovery. We are one of the few report providers with extensive drug development experience and we frequently use this knowledge to help clients source the most appropriate reports or produce reports for them from scratch.