Early invasive strategies for acute coronary syndromes.
Early coronary angiography and percutaneous or operative revascularization is now the treatment of choice for both ST- and non-ST-segment elevation acute coronary syndromes (ACS). In non-ST-segment elevation ACS this strategy produces a 18% to 22% reduction in ischemic outcomes at 6 months and prevents 1.7 deaths, 2.0 nonfatal infarcts and 20 readmissions per 100 treated patients at 1-year follow-up. Early angiography allows definition of coronary anatomy and assessment of left ventricular function, both important predictors of long-term risk. Intracoronary stenting and intravenous glycoprotein IIb/IIIa antagonists have improved outcome in percutaneous revascularization and should be used in the majority of ACS patients undergoing PCI. Initial costs are higher with an early invasive strategy; however, these are offset by reductions in rehospitalizations and later ischemic complications.
Quinn
Martin J
MJ
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Avenue, OH 44195, USA.
Brener
Sorin J
SJ
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors
D019039:Platelet Glycoprotein GPIIb-IIIa Complex