Current management and hospital outcome of the acute coronary syndromes

Current management and hospital outcome of the acute coronary syndromesPrimary percutaneous coronary intervention (pPCI) is the preferred reperfusion therapy for patients with an STsegment elevation myocardial infarction (STEMI) when it is performed as soon as possible after the first medical contact. 1 The PCI reperfusion approach remains superior to immediate thrombolysis (TL), even when transfer to an angioplasty center is necessary.2 Primary PCI is the preferred treatment for patients in shock and for the patients with contraindications to thrombolysis.By contrast, both the European Society of Cardiology (ESC) and ACC/ AHA guidelines for patients with non-STEMI recommend an immediate invasive strategy within 2 h of presentation for very high-risk patients, an early invasive strategy within 24 h in high risk patients and an invasive strategy within 72 h in intermediate risk patients.Finally, both ESC and ACC/AHA also provide a 1A recommendation for the radial approach in experienced centers.3 Despite these advantages, data from several national registries and surveys indicate that the use of pPCI is not universally implemented, and thrombolysis is still used in many patients.4 Furthermore, a large proportion of patients presenting with STEMI do not receive reperfusion therapy.A survey by Peter Widimisky in 2008 indicated that patient access to reperfusion therapy and the use of primary PCI or thrombolysis vary considerably between European countries.Northern, western and central Europeans countries use primary PCI for the majority of their STEMI patients.Southern Europe and the Balkans still predominantly use TL, and as a result, many patients are do not receive reperfusion therapy.5 Greece participated in this European survey and provided data from a large countrywide survey in the HELIOS study, which was published in 2007.The HELIOS survey showed a suboptimal pPCI implementation in Greece, which was also documented in the same period of time in another five European countries.The predominant reperfusion therapy was