Interventional Management of Coronary Artery Disease: Acute Coronary Syndromes

Bawamia, B; Sinclair, H; Veerasamy, M; Kunadian, V

doi:10.1007/978-3-642-37078-6_71

Interventional Management of Coronary Artery Disease: Acute Coronary Syndromes

Lookup NU author(s): Dr Bilal Bawamia, Dr Murugu Veerasamy, Professor Vijay Kunadian ORCiD

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Abstract

© 2015 Springer-Verlag Berlin Heidelberg, All rights reserved. Emergent or urgent percutaneous coronary intervention (PCI) is an established interventional treatment for patients with acute coronary syndrome (ACS). Timely delivery of primary angioplasty to the occluded coronary artery in ST-segment elevation myocardial infarction (STEMI) saves lives compared to medical therapy. Stenting, radial access, and newer periprocedural agents have further improved patient outcomes, but optimizing myocardial microvascular reperfusion after restoration of epicardial coronary flow remains a challenge. Risk stratification is central to the interventional management of non-ST-segment elevation ACS (NSTE-ACS). In high-risk patients, PCI helps to relieve symptoms, reduce hospital stay, and improve prognosis. The aim of this chapter is to describe the evidence-based procedural aspects, adjuncts, and periprocedural pharmacotherapy in the interventional management of STEMI and NSTE-ACS, with relevant references to the most recent American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) and European Society of Cardiology (ESC) guidelines. In addition, the role of urgent or emergent PCI in the high-risk settings of cardiogenic shock and cardiac arrest as well as in specific subgroups such as the elderly is reviewed. Finally, intracoronary imaging in the context of ACS is discussed.