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Revascularization Modalities in Acute Coronary Syndrome: A Review of the Current State of Evidence
Tahoora A Surve1, Maitha A Kazim2, Mehak Sughra3
1Internal Medicine, K. J. Somaiya Medical College, Mumbai, IND.
Insights
Revascularization strategies like CABG and PCI are crucial for acute coronary syndrome (ACS). The best approach depends on patient factors, disease complexity, and clinical outcomes, guided by heart teams and current guidelines.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Acute coronary syndrome (ACS) is a major global cause of death.
- Effective prevention, diagnosis, and intervention are critical for ACS management.
- Revascularization procedures are key to managing ACS, complementing medical therapy.
Purpose of the Study:
- To review revascularization strategies for ACS management.
- To analyze the 2018 ESC/EACTS guidelines and current literature on revascularization.
- To assess the alignment of guidelines with recent advancements in ACS treatment.
Main Methods:
- Literature review and analysis of existing studies.
- Examination of the 2018 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines.
- Evaluation of revascularization methods including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
Main Results:
- Both CABG and PCI show favorable outcomes in ACS management.
- Optimal revascularization choice requires individual patient assessment, considering anatomy, comorbidities, and age.
- Decisions on culprit vs. total, and immediate vs. staged revascularization depend on disease complexity and clinical outcomes.
Conclusions:
- Revascularization decisions for ACS are complex and multifactorial.
- A multidisciplinary heart team approach is essential for evidence-based decision-making.
- Ongoing evaluation is needed to align guidelines with evolving revascularization techniques and outcomes.
Abstract:
Acute coronary syndrome (ACS) stands as a leading global cause of mortality, underscoring the importance of effective prevention, early diagnosis, and timely intervention. While medications offer benefits to many patients, revascularization procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and emerging hybrid approaches remain pivotal for ACS management. This review delves into the 2018 ESC/EACTS guidelines alongside an analysis of existing literature to shed light on the spectrum of revascularization methods. While both CABG and PCI demonstrate promising outcomes, the optimal choice between the two hinges on a comprehensive assessment of individual patient factors, anatomical complexity guided by advanced imaging, comorbidities, and age. The determination of whether to pursue culprit or total revascularization, as well as immediate or staged revascularization, is contingent upon various factors, including age, disease complexity, and clinical outcomes. This evidence-based decision-making process is orchestrated by a multidisciplinary heart team grounded in ongoing clinical evaluation. The primary objective of this review is to provide valuable insights into revascularization strategies and scrutinize the congruence of current guidelines with recent advancements in the field.
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