Revascularization and reperfusion therapy
This chapter focuses on revascularization and reperfusion therapy in the setting of ACS. Revascularization therapy is distinct from reperfusion therapy. The former takes place in non-ST-elevation or ST-elevation ACS, while reperfusion is employed only for ST-elevation myocardial infarction. Revascularization therapy for non-ST-elevation ACS is usually considered an urgent condition unless there are signs of hemodynamic or electrical instability, in which case it is performed immediately. Instability in these patients may indicate a large burden of jeopardized myocardium or rather a disguised ST-elevation myocardial infarction, which, for example, can be seen with a circumflex artery occlusion. In contrast, reperfusion therapy is an emergent condition since it characterizes a state of coronary occlusion. A small subset of non-ST-elevation myocardial infarction patients will only receive medical therapy, even after coronary angiography. Revascularization is usually accomplished percutaneously, although some of these patients will be referred for surgical revascularization. While thrombolytic therapy is contraindicated for non-ST-elevation myocardial infarction, it has an important role in ST-elevation myocardial infarction when primary angioplasty is not readily available. Our discussion will begin with revascularization therapy and then move into reperfusion therapy.
KeywordsAcute Coronary Syndrome Thrombolytic Therapy Reperfusion Therapy Optimal Medical Therapy Invasive Therapy
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