title: Acute coronary syndromes: treatment and risk stratification.
abstract: OBJECTIVE
  Acute coronary syndromes result from a disruption of a vulnerable coronary plaque complicated by intraluminal thrombus formation, embolisation, and variable degrees of coronary obstruction. Patients with total occlusion may present with acute ST Elevation Myocardial Infarction (STEMI). Partial vessel obstruction may result in Non-ST-Elevation Acute Myocardial Infarction (NSTEMI) or unstable angina (UA). Clinical symptoms and electrocardiographic changes are the main components of identification of ACS. The rapid and effective triage of such patients regarding presence or absence of ST-segment elevation is critical to dictate further therapeutic strategies. The objective of this chapter was to review current evidence and recommendations for the evaluation and early treatment of acute coronary syndromes.
  
  
  BACKGROUND
  We performed a clinical review using the electronic databases MedLine and LILACS from January 1990 to September 2007.
  
  
  CONCLUSIONS
  Reperfusion of the infarct-related artery is the cornerstone of therapy for STEMI. Fibrinolysis and percutaneous coronary intervention are both well established as effective options. Management of UA/NSTEMI patients requires early risk stratification. High-risk patients should undergo an early invasive strategy that consists in performance of cardiac catheterization in the first 24 to 48 hours of presentation.
authors.affiliation: Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein.
authors.forename: Antonio Eduardo Pereira
authors.initials: AE
authors.lastname: Pesaro
authors.affiliation: Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein.
authors.forename: Paulo Cesar Gobert Damasceno
authors.initials: PC
authors.lastname: Campos
authors.affiliation: Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.affiliation: Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein.
authors.forename: Thiago Domingos
authors.initials: TD
authors.lastname: Corrêa
authors.affiliation: Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein.
authors.forename: Elias
authors.initials: E
authors.lastname: Knobel