Lege Artis Medicinae

[LIPID LOWERING IN ACUTE CORONARY SYNDROME]

MÁRK László

NOVEMBER 30, 2005

Lege Artis Medicinae - 2006;16(01 klsz)

[A large number of studies have proved that in acute coronary syndrome the administration of statins improves clinical outcome by their lipid lowering effect, and also by stabilizing the plaque as part of their pleiotropic effects. An important question regarding statin therapy is when it should be introduced after the onset of symptoms. Studies on this issue agree that statin therapy should be initiated right after the onset of acute symptoms. If the patient is already receiving statin, we must make sure it is not abandoned. According to current Hungarian guidelines, for patients with acute coronary syndrome the target level of the low density lipoprotein cholesterol is 1.8 mmol/l.]

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[PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROME]

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[Recently the indications of percutaneous coronary intervention have changed both in the ST elevation and in the non-ST elevation, unstable angina group of acute coronary syndrome. Current indications in these groups are briefly reviewed and the outcomes and indications of primary interventions or those following successful or unsuccessful thrombolysis are discussed based on the most recent guidelines. Of the technical aspects, experience of the person performing the intervention, the issue of stent implantation or balloon expansion, and protection against embolism are mentioned.]

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[Treatment of acute coronary syndrome has extensively changed during the last two to three decades. Improvement of medical care resulted in a strikingly lower hospital mortality, at least for acute coronary syndrome with ST-segment elevation. Currently, invasive revascularisation procedures have stepped into the limelight of medical activities. The success of this instrumental intervention has been due the development of aggressive adjuvant antithrombotic therapy. In our country, management of patients with acute coronary syndrome has also changed fundamentally, restructuring care system. This has at the same time resulted in better adherence to professional guidelines.]

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[The role of coronary care units with no facility for percutaneous intervention in the treatment of acute coronary syndrome has been greatly changed since pharmacological reperfusion approaches have been replaced by mechanical techniques, also with a wider indication. The planning of the traditional emergency treatment of patients admitted to such intensive care units depends on the necessity and possibility of primary percutaneous coronary intervention. Considering today’s professional requirements, all coronary care units, places of high patient turnover and employing highly qualified personnel, should be supplemented with facility for percutaneous coronary intervention.]

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