Abstract

Interventional treatment

The choice of an invasive strategy for the treatment of acute coronary syndrome (ACS) depends strictly on the initial clinical manifestation and ST-segment changes (elevation or depression) observed in ECG. Patients presenting with acute chest pain and ST-segment elevation ACS require urgent reperfusion therapy. Primary PCI of the culprit vessel is the preferred strategy within a specific time frame from the diagnosis to the intervention that should not be exceeded. The new 2020 ESC Guidelines on the management of patients with non-ST-segment elevation ACS (NSTE-ACS) recommend an immediate (<2 h) or early (<24h) invasive strategy for very-high-risk or high-risk patients respectively. The risk assessment is based on clinical signs and symptoms, ECG changes as well as serial evaluation of high-sensitive cardiac troponin level. For low-risk NSTE-ACS patients, a selective invasive strategy is recommended based on a non-invasive assessment of inducible ischemia or computed tomography coronary angiography. For all patients scheduled for coronary angiography and PCI (radial approach), the use of new generation drug-eluting stents is recommended. Complete revascularization should be achieved as early as possible in all ACS patients with multivessel disease. Routine ad-hoc PCI of non-culprit vessels should be postponed in all STEMI patients as well as ACS patients in cardiogenic shock. Ad-hoc PCI of non-culprit vessels may be considered in hemodynamically stable NSTE-ACS patients. Patients with ACS and complex coronary artery disease are not suitable for PCI while those with mechanical complications of myocardial infarction should be referred for immediate or delayed cardiac surgery.

Piśmiennictwo

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