article: 1 from 1  
Acta clinica
2006, vol. 6, iss. 1, pp. 114-124
article language: Serbian
unclassified
Percutaneous coronary interventions in patients with acute coronary syndrome without ST segment elevation
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

e-mail: miodrag.ostojic@kcs.ac.yu

Abstract

Non ST segment elevation acute coronary syndrome (NSTE-ACS) comprises patients with unstable angina (UA) and/or acute myocardial infarction without ST elevation (NSTEMI). Patoanatomical substrate and pathophysiological mechanism behind NSTE-ACS is predominantly rupture of the atherosclerotic plaque (but fissure or erosion can be also a cause) with consequential formation of intraintimal and intraluminal thrombus which do not occlude 100% coronary artery. So some patency and flow through the coronary artery is still preserved. In contrast to the myocardial infarction with ST elevation (STEMI) where mortality is high and therapeutic strategy is clear, in NSTE-ACS mortality is several times lower so following the principle "primum non nocere" that has been wondering for long time in finding the best therapeutic approach in those patients. According to Guidelines for Percutaneous Coronary Interventions published by European Society of Cardiology in May 2005 percutaneous coronary interventions (PCI) in NSTE-ACS were recommended as the treatment of choice in those patients who were in the high risk for the progression into STEMI or malignant arrhythmias and the sudden death. PCI should be undertaken very early (during the first ours or days) after the appearance of symptoms and signs. In patients with NSTE-ACS with low risk medical stabilization could be attempted and afterwards by noninvasive detection of ischemia if it is found proceed with coronary angiography and PCI if appropriate. But one always has to keep in mind the advice that was given in 12 years old American recommendations for the treatment of NSTE-ACS patients" The decision about which strategy (early invasive or early conservative) to pursue for a given patient should be based on the patient’s estimated risk, available facilities, and patient preference (AHCRP Guideline 1994)".

Keywords

unstable angina; myocardical infarction without ST elevation; percutaneous coronary interventions; drug therapy

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