Acute Coronary Syndrome Catheter Interventions

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Acute coronary syndrome (ACS) is among the most common diseases practitioners encounter in the inpatient setting. This syndrome comprises a spectrum of obstructive coronary artery disease that most commonly arises from plaque rupture and/or erosion, leaving the vulnerable lipid-rich core exposed to the circulation, resulting in activation of platelets and the coagulation cascade leading to acute thrombotic occlusions.

Each stage of this syndrome can be treated differently based on clinical presentation, but a catheter-based interventional approach is often preferred. For years, the primary treatment of ACS revolved around maximizing medical therapy with the use of antiplatelet and anticoagulation therapy, anti-anginal medications, and aggressive lipid-lowering and risk factor modification. In 1958, the advent of thrombolytics shifted the paradigm in the approach and treatment of ACS. First used by Fletcher and colleagues and later validated by trials such as ISIS, GUSTO, and GISSI, intravenous administration of thrombolytics could successfully treat acute thrombotic occlusions, mainly in regards to STEMI. However, even with the improvement in survival, size of the infarct, and overall morbidity, thrombolytic therapy continued to demonstrate major bleeding issues, including intracranial hemorrhage, as well as issues with reinfarction. The most effective thrombolytic regimens achieve angiographic infarct-artery patency in only 50% of patients within 90 minutes. Bleeding requiring transfusion occurs in 5% of patients and stroke in 1.8% with these regimens. The management of ACS showed gradual improvement; however, outcomes were still poor due to these issues - this all changed in 1977 when Andreas Gruentzig developed a novel approach to treat ACS with the use of balloon angioplasty, forever changing the landscape of cardiology and would later be known as the father of interventional cardiology.

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