The acute coronary syndromes: advances in medical and interventional management

Unstable angina is one of the commonest reasons for hospital admission. It is not a benign diagnosis: within 2 weeks of admission acute myocardial infarction develops in about 12%. Subsequently, the rate of fatal myocardial infarction is 4% within 1 year. Medical therapy has undergone enormous change in the last few years and is highly effective with around 90% of patients being stabilized by combinations of agents including aspririn, beta-blockers, low molecular weight heparin, statins and more recently glycoprotein IIb-IIIa receptor inhibitors. There have also been monumental advances in identification of patients who are at highest risk of further cardiac events by utilization of risk stratification that is dependent upon both clinical condition and also, more recently, on serum concentrations of the cardiac specific proteins, troponins T & I. Finally, percutaneous coronary angioplasty with stent insertion has revolutionised the revascularization of patients with on-going ischaemia and also those now known to be at high risk of further cardiac events. PTCA has recently been shown to improve prognosis in this group as well as remove their symptoms in a highly effective manner.