EuroPCR 2008 dedicated a full day to the |
Acute Coronary Syndrome |
 view the sessions on video on EuroPCR in-a-box |
A major topic covered during the second day of EuroPCR 2008, annual course in interventional cardiology, was the Acute Coronary Syndrome (ACS). The first session in the day’s series, chaired by Professors Weidinger and Bassand was titled “  Management of patients with non-ST segment elevation acute coronary syndromes” and attracted a large audience. |
The opening ACS session included three live cases, transmitted from the Clinique Pasteur -Toulouse, France, and one of these was featured by a 50-year old male smoker. The patient had ACS along with  three-vessel disease and was evaluated as high-risk. During the session, Professor Fajadet explained that his team consults a surgeon daily and implements a multidisciplinary approach. A percutaneous intervention, PCI, was the most suitable option for this patient and the team found that the culprit lesion required immediate treatment. |
The panel in Barcelona decided that the balloon was the first choice and then two 20 millimetre stents were used, due to the length of the ostial lesion. |
| Improved care for patients thanks to new guidelines |
During the same ACS session, Professor Fox presented what he defined as “ two excellent sets of new guidelines” that will result in better care for patients. “The recently issued ESC and ACC/AHA guidelines on non-ST elevated myocardial infarction are both very comprehensive.” He highlighted the existence of new definitions for myocardial infarction, consistency in measuring the score of risk and encouraged a multimarker approach to stratifying patients. |
As for revascularisation and invasive evaluation, the ESC guidelines recommend angiography and revascularisation for patients with heart failure and recurrent angina should be addressed in less than 2 hours. Patients determined as high risk should be invasively evaluated in less than 72 hours. |
The use of anticoagulation is recommended in all cases though care must be taken to avoid haemorrhage. New trials show enoxaparin to be more efficient than and as safe as unfractionated heparin (UFH). This is, however, not the case in patients undergoing PCI. Recommendation is to use fondaparinux in cases that are not urgent but should not be used alone in PCI. |
He concluded that although some differences do exist between European and US guidelines they are, in essence, very similar. |
| Strategy to define risk |
| The session also covered the area of risk strategy concluding that risk management should start with a clinical presentation followed by an ECG within 10 minutes of presenting. This should be followed by lab value analysis including troponans, glycol-metabolic values and creatine clearance. |
The risk score is of vital importance and the recommended scoring system to be used, in Europe, is GRACE. |
Other useful links |
| Acute coronary syndrome day - Part II - Management of patients with ST-segment elevation myocardial infarction |
| View the Acute Coronary Syndrome day on video on EuroPCR in-a-box |
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