Managing Acute Coronary Syndrome: Current Approach, Strategy and Recommendations

Acute Coronary Syndrome accounts for a majority of morbidity and mortality related to Coronary Artery Disease (CAD). As compared to west, more number of ACS patients in India present with STEMI than NSTEMI with a high rate of mortality. The hallmark of ACS is a sudden imbalance between the amount of myocardial oxygen consumption and the oxygen demand. ACS is commonly associated with three clinical manifestations: ST elevation myocardial infarction, Non ST elevation myocardial infarction or Unstable angina. The 12-lead ECG is at the heart of the decision pathway in the management of ischemic chest pain and is the only means of identifying STEMI. In NSTEMI, determination of the preferred management strategy depends on the patient's clinical characteristics and clinical risk. STEMI patients require immediate reperfusion either by Fibrinolysis, Primary PCI or a combination of the two (Pharmaco-invasive approach). Primary PCI is the therapy of choice in STEMI if delivered in less than 120 mins. Fibrinolysis remains a valuable alternative in some clinical situations. Given the dearth of Interventional Cardiologists, PCI capable hospitals and various patient logistic issues, Pharmaco-invasive approach looks the most appropriate option for Indian scenario.