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Abstract
Recently the incidence of coronary artery disease has been increasing in Korea. Percutaneous coronary intervention (PCI) has been established as one of the most effective therapeutic methods in addition to medical therapies, especially for patients with acute coronary syndrome (ACS). ACS refers to unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). UA/NSTEMI is a common but heterogeneous disorder with patients exhibiting a wide variety of risks. In patients with UA/NSTEMI, early risk stratification is at the center of the management program and can be achieved by using clinical criteria, electrocardiographic changes and biomarkers, or both. Platelet glycoprotein (GP) IIb/IIIa receptor blockers are indicated in high-risk patients who are likely to undergo PCI, but are not indicated in the management of lower risk patients who do not undergo PCI. There is a hard evidence to support the substitution of the lowmolecular weight heparin for unfractionated heparin. Many recent trials have demonstrated the benefit of an early invasive strategy with coronary angiography followed by PCI in patients at high and intermediate risk. Prompt reperfusion of ischemic myocardium is the major focus of acute treatment of patients with STEMI. Two reperfusion strategies have been developed: thrombolytic therapy and primary PCI. Although these two strategies have traditionally been considered distinct and at times competing options, it is likely that the care of patients with STEMI will be improved in the future if they are viewed as a single integrated effort for reperfusion. However, PCI has been shown to be superior to thrombolysis in the treatment of STEMI admitted to highly experienced PCI centers. A meta-analysis of many randomized trials found significantly lower mortality rate, and lower rate of nonfatal reinfarction and intracerebral hemorrhage with primary PCI compared with thrombolysis. Currently, a primary PCI strategy may begin with the initiation of a platelet GP IIb/IIIa receptor blocker in the emergency center, together with aspirin and heparin (especially low molecular weight heparin), followed by rapid application of coronary angioplasty with stenting. Primary PCI is feasible in community hospitals without surgical capability, however, due to the concerns about timing and safety margin, this approach is not yet advocated in the current guidelines.
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