[Pathogenesis and treatment of acute coronary syndromes]

Area of Science:

• Cardiology
• Internal Medicine
• Public Health

Context:

• Acute coronary syndromes (ACS) represent a significant public health challenge with substantial epidemiological and economic impact.
• The incidence in the Polish population is estimated at 250,000 cases per year, with concerning 30-day mortality rates of 3.5% for UA/NSTEMI and 8.4% for STEMI.
• Atherosclerotic plaque instability, driven by inflammation, is the primary pathophysiological mechanism underlying ACS.

Purpose:

• To outline the current understanding and management strategies for acute coronary syndromes (ACS).
• To detail the treatment goals for both unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
• To highlight the role of percutaneous coronary intervention (PCI) and emerging pharmacological approaches in improving ACS outcomes.

Summary:

• ACS encompasses UA/NSTEMI and STEMI, characterized by atherosclerotic plaque rupture and thrombus formation.
• Key risk factors include advanced age, diabetes, history of stroke or myocardial infarction, and elevated cardiac troponins.
• Treatment guidelines emphasize reducing mortality and recurrent ischemia through plaque stabilization, revascularization, and pharmacological therapies.
• For STEMI, rapid restoration of culprit vessel patency via PCI or thrombolysis is crucial, with PCI demonstrating a lower risk of death and reinfarction.

Impact:

• Effective management of ACS is critical to reduce mortality and morbidity, thereby alleviating healthcare burdens.
• Percutaneous coronary intervention (PCI) is a preferred strategy for STEMI due to its superior safety and efficacy compared to fibrinolysis.
• Ongoing research into facilitated PCI and novel pharmacological regimens aims to further enhance treatment effectiveness and patient outcomes.