[Acute coronary syndrome: technological improvements in diagnostics and therapy]

Unstable angina pectoris and non-Q wave infarction are difficult to distinguish clinically and electrocardiographically and currently are often called 'acute coronary syndrome'. In the technology of diagnosis and treatment there have been a number of innovations. The early diagnosis can be improved by means of plasma assays of the highly sensitive and specific cardiac markers troponin I and T. Both the pharmacotherapy (new platelet aggregation inhibitors) and the invasive treatment (use of coronary stents and arterial bypasses) have undergone major--expensive--innovations. Randomized trials have not yet made it clear whether invasive or conservative therapy is the optimal initial treatment. Both invasive treatment and pharmacotherapy are changing rapidly, so that the results of the randomized trials are already less relevant to the cardiological practice of 1999.