Invasive Therapy in Non-ST-Segment-Elevation ACS
Invasive Therapy in Non-ST-Segment-Elevation ACS
While outcomes for ST-segment-elevation myocardial infarction has significantly decreased over the last years, patients presenting with non-ST-segment-elevation acute coronary syndromes (NSTEACS) still have a rather high mortality. Longer term mortality over 4 years is about double the mortality after a ST-segment-elevation myocardial infarction. The reason for the poorer prognosis is unclear but is very likely to be partially explained by the generally older age of NSTEACS patients. The optimal therapy for NSTEACS is less well defined. In this review, the authors specifically discuss the role of coronary angiography, how to decide which patient should undergo this procedure and whether there is an optimal time point. The review provides an up-to-date discussion about the best treatment strategies for NSTEACS.
The treatment for ST-segment-elevation myocardial infarction (STEMI) has received a lot of attention over the last decades, with concerted efforts to offer primary percutaneous coronary intervention to most patients in Western countries. Guidelines on optimal treatment for STEMI are rather unambiguous. Non-ST-segment-elevation acute coronary syndromes (NSTEACS), which include non-ST-segment-elevation myocardial infarction (NSTEMI) and unstable angina, is a more common clinical presentation of coronary artery disease and associated with higher mortality compared with STEMI. The annual incidence is about three per 1000 inhabitants and the longer-term mortality over 4 years is about double the mortality after a STEMI.
The reason for this worse prognosis is unclear, but partially explained by the fact that NSTEACS patients tend to be older than STEMI patients and they often have multivessel disease. The optimal therapy for NSTEACS is less clear, also because NSTEACS covers a broader range of disease severity. Which patient should undergo coronary angiography, which patient should be revascularized and how soon? These are the questions that are not as clear and which the authors discuss in this review. The authors will review the evidence for an invasive strategy and the optimal timing for the treatment of NSTEACS.
Abstract and Introduction
Abstract
While outcomes for ST-segment-elevation myocardial infarction has significantly decreased over the last years, patients presenting with non-ST-segment-elevation acute coronary syndromes (NSTEACS) still have a rather high mortality. Longer term mortality over 4 years is about double the mortality after a ST-segment-elevation myocardial infarction. The reason for the poorer prognosis is unclear but is very likely to be partially explained by the generally older age of NSTEACS patients. The optimal therapy for NSTEACS is less well defined. In this review, the authors specifically discuss the role of coronary angiography, how to decide which patient should undergo this procedure and whether there is an optimal time point. The review provides an up-to-date discussion about the best treatment strategies for NSTEACS.
Introduction
The treatment for ST-segment-elevation myocardial infarction (STEMI) has received a lot of attention over the last decades, with concerted efforts to offer primary percutaneous coronary intervention to most patients in Western countries. Guidelines on optimal treatment for STEMI are rather unambiguous. Non-ST-segment-elevation acute coronary syndromes (NSTEACS), which include non-ST-segment-elevation myocardial infarction (NSTEMI) and unstable angina, is a more common clinical presentation of coronary artery disease and associated with higher mortality compared with STEMI. The annual incidence is about three per 1000 inhabitants and the longer-term mortality over 4 years is about double the mortality after a STEMI.
The reason for this worse prognosis is unclear, but partially explained by the fact that NSTEACS patients tend to be older than STEMI patients and they often have multivessel disease. The optimal therapy for NSTEACS is less clear, also because NSTEACS covers a broader range of disease severity. Which patient should undergo coronary angiography, which patient should be revascularized and how soon? These are the questions that are not as clear and which the authors discuss in this review. The authors will review the evidence for an invasive strategy and the optimal timing for the treatment of NSTEACS.