Comparison of ischemic syndromes of the brain and heart
| Characteristic | Acute ischemic stroke syndromes | Acute coronary syndromes |
|---|---|---|
| Pathophysiology | Heterogeneous: cardioembolic, artery-to-artery embolization, small-vessel disease, cryptogenic or embolic stroke of undetermined source (also known as ESUS) | Homogeneous: rupture of plaque and in situ formation of occlusive thrombus (most cases) |
| Diagnosis | Clinical; imaging is mandatory and used for treatment decisions | Clinical assessment, electrocardiography and imaging used for risk stratification and prognostication |
| Thrombolytics | Alteplase (tPA) is standard; other thrombolytic agents still under investigation | Tenecteplase is standard; alteplase (tPA), reteplase and streptokinase are alternative proven therapies |
| Endovascular therapy | Endovascular thrombectomy proven for patients selected by imaging and with fast treatment paradigms | Primary percutaneous coronary intervention established for STEMI, within 12 h of symptom onset |
| Organized care units or wards | Associated with proven improvement in mortality and morbidity, but not yet widely established throughout Canada | Shown to improve mortality and morbidity; well established worldwide |
| Milder clinical syndromes | TIA and minor stroke require same-day assessment, diagnosis and management to prevent major acute stroke | Unstable angina and NSTEMI require urgent assessment, diagnosis, risk stratification and often invasive management to prevent major cardiovascular events |
Note: NSTEMI = non-ST-elevation myocardial infarction, STEMI = ST-elevation myocardial infarction, TIA = transient ischemic attack, tPA = tissue plasminogen activator.