Early intervention: which patients and how early?
Despite advances in preventive therapy, acute coronary syndromes (ACS) remain a significant cause of morbidity and mortality. Patient risk varies widely along a spectrum from unstable angina to ST-segment elevation myocardial infarctions (STEMIs) and can be estimated using risk prediction algorithms. Estimated risk is useful to select therapeutic options ranging from aggressive medical therapy for patients at low risk to revascularization for high-risk patients in whom bypass or percutaneous coronary intervention (PCI) is feasible. Appropriate timing of an invasive strategy is crucial, with early intervention maximally benefiting the highest-risk patients. Facilitated PCI's role in patients who present with STEMI and the most appropriate timing of interventional therapy in patients at moderate risk after a non-ST-elevation ACS remain the subject of ongoing debate.
Brennan
J Matthew
JM
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC 27705, USA. brenn009@mc.duke.edu
Petersen
John L
JL
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors