Acute Coronary Syndrome without ST Elevation. Tactics in Present Therapy

Overview

Acute coronary syndrome without ST elevation is represented by an unstable angina pectorisand myocardial infarction without ST elevation. This clinically precisely defined unit has beenthe subject of continual all-world interest on cardiologists over the last decade. The main reasonlays in the fact that the strategy of treatment in the course of years recognized significantchanges and it is fair to say that, in contrast to myocardial infarction with ST elevations, it isnot yet unified. There is no unified opinion in various cardiology recommendations (guidelines)either. The stratification of risk plays an important role in the decision process. Although aninvasive diagnostic and intervention procedure in the shortest possible interval has beenrecommended in the high-risk patients, it is possible towait and select a conservative treatmentin clinically stable patients. Some randomized multicentric studies of the last years favor earlyrevascularization and interventional cardiologists evidently endorse such opinion. The availabilityof invasive diagnostics and revascularization techniques plays an important role in thedecision-making concerning the therapeutic tactics. A revolutionary breakthrough in the drugtherapy has been offered by the use of clopidogrel before as well as during long period of timeafter the planned intervention as a cause to prevent death/myocardial infarction. On the otherhand, the administration of the platelet GP IIb/IIIa receptor inhibitors is presently criticizedby many authors.The present article summarizes, in a clinically understandable and relatively short way, thepresently existing opinions on acute coronary syndrome without ST elevation. It is not obviousat the present time, for how long period of time these views will be valid.

Key words:
acute coronary syndrome without ST elevation (NSTEMI) - unstable angina pectoris- myocardial infarction without ST elevation.