[Treatment of acute coronary heart disease in medical practice]

Area of Science:

• Cardiology
• Pharmacology

Context:

• Despite advances in cardiac intensive care, overall mortality from myocardial infarction remains a concern.
• Current therapeutic measures have not substantially reduced overall myocardial infarction mortality.
• Improved management strategies are needed for advanced coronary heart disease, particularly for high-risk subgroups like unstable angina patients.

Purpose:

• To propose a more effective management strategy for patients with advanced coronary heart disease, focusing on unstable angina.
• To outline a tiered treatment approach for out-patients with recent onset or crescendo angina on effort.
• To emphasize the importance of timely intervention and appropriate drug combinations.

Summary:

• The proposed treatment scheme for unstable angina involves a stepwise approach: beta-blockers as the first step, followed by calcium channel blockers and long-acting nitrates.
• An anti-platelet aggregating agent should be administered in all cases.
• If medical treatment is ineffective within days, surgical intervention should be considered.

Impact:

• This approach aims to improve the detection and treatment of high-risk subgroups, potentially reducing mortality and hospitalizations.
• Optimizing anti-anginal drug regimens and medical care organization can lead to better patient outcomes.
• Facilitating timely surgical consideration for refractory cases ensures comprehensive patient management.