[Invasive approach to patients with acute coronary syndrome]

Cardiovascular diseases are the leading cause of mortality in Croatia. In concordance with this epidemiologic situation, a new organization of emergency medicine and a network of invasive cardiac laboratories have been introduced throughout Croatia. Main goal of this structuring is to improve the care of patients with acute coronary syndrome (ACS). The aim of this paper is to open discussion on the optimal way of treatment in patients with ACS in our country today, in the era of interventional cardiology of the 21st century. The pathophysiology of ACS encompasses a complex atheroinflammatory and atherothrombotic process with dynamic and progressive mechanical obstruction of coronary arteries and subsequently oxygen supply-demand mismatch. Conversely, the best way to treat such patients is reperfusion therapy, a goal nowadays achieved by either antithrombotic medical therapy or percutaneous coronary intervention (PCI). The weight of evidence does support the use of primary PCI as a standard and supreme reperfusion therapy, especially in myocardial infarction with ST elevation. The logistic complexities such as triage, transportation, the development of capable interventional center working 24-hours, even in developed countries, may be a major problem to use such a practice in the whole community. In ACS with non ST elevation, problems are even broader and include the importance of using optimal revascularization procedure (even cardiac surgery), timing and concomitant medical therapy, with certain stratification of every individual. Finally, especially for our country, medical and economic resources should be used optimally in order to achieve an optimal system to treat patients with ACS.