Percutaneous coronary interventions in acute coronary syndromes

2021 ◽  
pp. 549-564
Author(s):  
Andreas Mitsis ◽  
Marco Valgimigli
Keyword(s):  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
Haemodynamic Instability ◽  
Dramatic Improvement ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Acute coronary syndromes (ACS) remain the most common disease in acute cardiovascular care. Historically, two groups of patients should be differentiated based on initial ECG features: patients with ongoing chest pain and persistent ST-segment elevation and patients with acute chest pain but no persistent ST-segment elevation. The first condition is defined as STEMI and requires immediate reperfusion by primary angioplasty or fibrinolytic therapy. The second condition is defined as NSTE-ACS and consists a big spectrum of cases range from patients free of symptoms at presentation to individuals with ongoing ischaemia, electrical or haemodynamic instability or cardiac arrest. The different types of ACS must be differentiated as their prognosis and therapeutic strategy varies. However, over the last years, the early and broad use of percutaneous coronary intervention (PCI) as well as innovations in the adjunctive antithrombotic medication, including more effective P2Y12-Inhibitors and new generation DES resulted to a dramatic improvement of the prognosis across the whole spectrum of ACS patients.

Percutaneous coronary interventions in acute coronary syndromes

2016 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Criterion ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk

scholarly journals The Clinical Short-term Outcome of Atorvastatin and Trimetazidine Combination Treatment in Patients with Non-ST Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

2016 ◽  
Vol 8 ◽  
Author(s):  
Jiangyou Wang ◽  
Han Chen ◽  
Dan Song ◽  
Jian Peng ◽  
Xi Su
Keyword(s):  
Cardiac Function ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Short Term ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

<p><strong>Background and Objectives: </strong>To investigate the effects of atorvastatin (ATV) and trimetazidine (TMZ) combination treatment in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention. <strong></strong></p><p><strong>Subjects and Methods: </strong>A total of 92 patients with NSTE-ACS were randomly divided into the pretreatment with ATV group (80mg 12h before PCI, with a further 20mg every day to 30th days after PCI, n=44) or the pretreatment with ATV (as the ATV group) and TMZ (60mg 30min before PCI, with a further 20mg tid to 30th days after PCI, n=48). Echocardiography was executed and plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) levels were measured just prior to the PCI and 30th days after PCI. The main end point was a 30-day incidence of major adverse cardiac events.</p><p><strong>Result: </strong>Major adverse cardiac events occurred in 9.1% of patients in the ATV group and 4.2% of those in the ATV+TMZ group (P=0.189). NT-pro-BNP of the two groups were decreased 30th days after PCI, however, NT-pro-BNP in the ATV+TMZ group were significantly lower than those in the ATV group (P&lt;0.05). Cardiac function in NSTE-ACS patients, as reflected by the increased LVEF, FS as well as decreased LVEDd (P&lt;0.05) in all groups at 30 days after intervention, but cardiac function parameters were more obviously improved in the group administered with ATV+TMZ (p&lt;0.05).</p><p><strong>Conclusion: </strong>Short-term pretreatment with the combination of ATV and TMZ administration prior to PCI can prominently decrease NT-pro-BNP and improve cardiac function compared to a single administration of the ATV. </p>

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