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Tactics of percutaneous coronary intervention in acute coronary syndrome without ST segment elevation

Some studies under development (for example, ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes Investigators)) use a more powerful antiplatelet regimen to challenge the current interventional strategy. The ISAR-COOL study compared the therapeutic (“cold”) strategy (prolonged antithrombotic preparation before the intervention) and immediate percutaneous coronary intervention in high-risk patients with ST segment depression (65%) and elevated troponin T (67%). The average catheterization period in the cold strategy group was 86 hours; in the immediate catheterization group - 2.4 hours. The primary endpoints, defined as death due to any cause and extensive nonfatal MI within 30 days, were observed in the cold strategy group in 11.6%; in the group with an immediate invasive strategy - 5.9% (p = 0.04). Complications that occurred before catheterization affected this result. The authors conclude that in patients with acute coronary syndrome without ST elevation, who are at high risk, delaying the intervention does not improve the results, and antithrombotic preparation should take the minimum time required to organize cardiac catheterization and revascularization (Recommendations for immediate, that is, after less than 2.5 hours of percutaneous coronary intervention in patients with acute coronary syndrome without ST elevation, belonging to the high-risk group: TS).

If for some reason the time between coronary angiography and percutaneous coronary intervention reaches 24 hours, you can also prescribe abciximab. Enoxaparin can be considered as a drug prescribed instead of unfractionated heparin for patients at high risk for complications of acute coronary syndrome without ST segment elevation in cases where invasive treatment tactics cannot be used.

So, patients with acute coronary syndrome without ST segment elevation (unstable angina or MI without ST segment elevation) must first be stratified by risk groups. The clear advantage of early angiography and subsequent revascularization (percutaneous coronary intervention or CABG) has been proven only for patients at high risk. Delaying the intervention does not improve the outcome. The predictability and immediate safety of routine stenting give reason to recommend this type of treatment.
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Tactics of percutaneous coronary intervention in acute coronary syndrome without ST segment elevation

  1. Percutaneous coronary interventions in acute coronary syndrome without ST elevation
    Percutaneous coronary interventions in acute coronary syndrome without segment elevation
  2. Determining the risk of rapid disease progression in acute coronary syndrome without ST segment elevation
    The importance of dividing patients with unstable angina and myocardial infarction without ST segment elevation into high and low risk groups for complications is justified by the fact that the clear advantage of performing early coronary angiography and, if necessary, percutaneous coronary intervention is determined only in patients at high risk for complications. In the recommendations of the European Cardiology
  3. Clinical protocol for providing medical care to patients with acute coronary syndrome without ST segment elevation (MI without Q wave and unstable angina)
    Heading for ICD-10: 120-122. Signs and criteria for diagnosing the disease Acute coronary syndrome is a group of symptoms and signs that make it possible to suspect acute myocardial infarction or unstable angina. The term "acute coronary syndrome" is used at the first contact with patients as a preliminary diagnosis. Acute coronary syndrome with persistent elevation of the ST segment on an ECG and without
  4. Coronarographic morphology of atherosclerotic lesions in acute coronary syndrome without ST segment elevation
    The development of acute coronary syndrome is directly related to the complicated “growth of the atherosclerotic plaque, which is accompanied by the formation of blood clots of various sizes and localization with respect to the structure of the plaque. The morphological composition of stable atherosclerotic plaques may vary in the ratio of structures that contribute to its stabilization or destabilization. With enough
  5. Facilitative percutaneous coronary intervention, rescue percutaneous coronary intervention, routine coronary angiography and percutaneous coronary intervention after thrombolytic therapy
    Facilitative percutaneous coronary intervention, rescue percutaneous coronary intervention, routine coronary angiography and percutaneous coronary intervention after thrombolytic
  6. ACUTE CORONARY SYNDROME WITHOUT SUSTAINABLE ST SEGMENT ELEVATION
    ACUTE CORONARY SYNDROME WITHOUT SUSTAINABLE SEGMENT ELEVATION
  7. Referral of patients for primary percutaneous coronary intervention
    There is no doubt that patients with contraindications to thrombolysis should be sent to the hospital in the first 12 hours from the onset of symptoms of acute myocardial infarction, where coronary angiography and primary percutaneous coronary intervention are possible, since the primary percutaneous coronary intervention is the only the ability to quickly open an artery.
  8. Interventional treatment of acute coronary syndrome with ST segment elevation
    Interventional treatment of acute coronary syndrome with segment elevation
  9. Clinical protocol for providing medical care to patients with acute coronary syndrome with ST segment elevation (MI with Q wave)
    ICD-10 rubric: I21-I22 Symptoms and criteria for diagnosing the disease Acute coronary syndrome with persistent ST elevation in most cases precedes acute myocardial infarction with Q wave. Acute myocardial infarction is necrosis of any myocardial mass due to acute prolonged ischemia. Clinical diagnostic criteria should be considered: - protracted (more than 20 min) anginal pain at rest; - the presence of typical
  10. Percutaneous coronary interventions in single discrete lesions of the coronary arteries, diffuse stenosis, multivascular lesion in coronary artery disease
    Percutaneous coronary interventions with single discrete lesions of the coronary arteries, diffuse stenosis, multivascular lesion with
  11. FROZEN CORONARY INTERVENTIONS IN CHRONIC IHD
    The era of percutaneous coronary interventions for coronary atherosclerosis takes an extremely small historical period to date: only about 30 years from the first balloon angioplasty performed at the A. Gruentzig Clinic. During this time, the procedure for non-surgical restoration of the lumen of the coronary arteries not only received global recognition and experienced an unprecedented
  12. Percutaneous coronary interventions after thrombolysis in the presence of ischemia
    The DANAMI-1 study was the first and only prospective randomized study to compare invasive tactics (percutaneous coronary interventions, CABG) in treating patients with the first MI and ST elevation, who had signs of cardiac ischemia before discharge from the hospital with conservative treatment tactics for such patients . Primary endpoints (death, recurrent heart attack,
  13. Percutaneous coronary interventions in the presence of bends in the bed of the coronary arteries, lesions of the mouth, calcified lesions, long lesions
    Percutaneous coronary interventions in the presence of bends in the bed of the coronary arteries, lesions of the mouth, calcified lesions, long
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