[Myocardial revascularization strategy in patients with acute coronary syndrome]

Acute coronary syndrome (ACS) represents a spectrum of conditions caused by activated malignant coronary disease, with one of the following outcomes: stabilization, myocardial infarction or sudden death. The strategies of diagnostic procedures and treatment for ACS have been developed on the basis of differentiation between the two main groups of patients: those with unstable angina pectoris (UAP) and non-ST-segment elevation myocardial infarction (NSTEMI), and those with ST-elevation myocardial infarction (STEMI). The diagnosis and treatment of STEMI patients have both temporal and spatial limitations, where rapid identification and use of revascularization strategy, generally from 6 to not more than 12 hours, are the mainstay of the respective algorithm. In contrast to this, in UAP/NSTEMI patients the nature of the disease usually allows for more time for the diagnosis and choice of most appropriate therapy, whereas the chance of saving practically the entire myocardial area is much greater. Proposals of the possible algorithms for the procedures to be used in the diagnosis and management of ACS, based on the real possibilities available in the Republic of Croatia, and some our own results are presented in this review.