[Therapeutic strategy and long-term prognosis of acute coronary syndrome].
The relation between initial therapeutic strategy and long-term prognosis was reviewed in patients with acute coronary syndrome. In the Q wave infarction, the effectiveness of reperfusion therapy has been established. The earlier ischemic myocardium is reperfused, the better is its prognosis. The long-term prognosis becomes better when TIMI 3 flow is obtained after the reperfusion therapy. Direct PTCA, which can obtain TIMI 3 flow in more than 90% of the patients, has showed lower mortality, lower rate of reocclusion and lower rate of cerebrovascular accident than thrombolytic therapy. As for the long-term efficacy of stent implantation, several more years are needed although early outcomes of primary stenting are impressive. The lesions in patients with non-Q wave myocardial infarction or unstable angina frequently show severe stenosis with platelet-rich thrombi. This type of lesion is thought to be unstable and the chance of cardiac events are high when percutaneous intervention or bypass surgery is performed during this period. Thus, the conservative strategy with waiting for 1 to 2 weeks to stabilize the plaque has been recommended. However, in the long span, the prognosis of unstable angina seems not bad after the complicated early course. The long-term prognosis of unstable angina could be affected by the early outcome.
Isshiki
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Department of Medicine (Cardiology), Teikyo University School of Medicine.
D000789:Angina, Unstable / Q000401:mortality / Q000628:therapy*; D016757:Death, Sudden, Cardiac; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis