Percutaneous transluminal coronary angioplasty in acute ischemic syndromes

Acute myocardial ischemic syndromes are apparently related to the underlying pathophysiology leading to the clinical instability. Depending on the completeness and the duration of blood deprivation, different clinical syndromes result, such as sudden death, acute transmural infarction, nontransmural infarction, or unstable angina. Recent clinical, angiographic, and pathologic studies have emphasized the important pathophysiologic link between unstable angina, acute myocardial infarction, and early postinfarction angina. The term unstable angina is used for prolonged episodes of myocardial ischemia at rest in the absence of detectable myocardial necrosis. However, in the acute situation, when a patient presents with chest pain and electrocardiographic signs of ischemia, the distinction between unstable angina and myocardial infarction is often difficult. The uncertainty of outcome in a specific patient forces one to provide maximal treatment. The prime goal of any intervention in this situation must primarily be the preservation or early restoration of antegrade flow in the ischemia-related artery, in order to resolve myocardial ischemia and to prevent (further) myocardial necrosis, and so to improve both shortand long-term mortality and morbidity. Despite the latest substantial improvements in surgical techniques, cardioplegia, anaesthesia, and postoperative care, there is still no consensus as to the safety of surgery in the management of these subsets of patients. As an attractive alternative to coronary artery bypass surgery, percutaneous transluminal coronary angioplasty would logically play an important role in the management of patients with acute myocardial ischemic syndromes.