Exploring new strategies for the management of acute coronary syndromes.
Patients who present today with an acute coronary syndrome face a substantially lower risk of death, recurrent myocardial infarction, or severe ischemia than patients did a decade ago. Researchers are pursuing new strategies to further improve the outcomes of patients with acute coronary syndromes. These strategies may be grouped into 3 paradigms: (1) restoration and maintenance of coronary flow at the site of culprit lesion; (2) reduction of infarct size, reperfusion injury, and postischemic dysfunction; (3) stabilization of the coronary arterial wall and its interaction with the bloodstream to reduce recurrent ischemic events. The last approach encompasses strategies to alter the underlying vascular pathophysiology that leads to plaque instability and coronary thrombosis. Investigation into each of these paradigms may yield new strategies that will be incorporated into standard clinical management of acute coronary syndromes in coming years. With so many mechanistically different approaches to the management of acute coronary syndromes, clinicians have reason for optimism that continued progress will further reduce the morbidity and mortality associated with acute coronary syndromes and the likelihood of their recurrence.
Schwartz
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Cardiology Section, Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center, 80220, USA.
D000208:Acute Disease; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003326:Coronary Circulation; D003327:Coronary Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D012107:Research Design; D013577:Syndrome; D018754:Ventricular Dysfunction / Q000209:etiology / Q000517:prevention & control
D000924:Anticholesteremic Agents