Advances in the therapy of acute coronary syndrome
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
19
Journal Issue
2
Pages
91-102
Date Issued
2008-04
Author(s)
Abstract
Acute coronary syndrome consists of two categories: ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE ACS). Recent results of clinical trials relating to STEMI were focused at how to shorten myocardial ischemic time, and how to reduce the distal embolization resulting from primary percutaneous intervention (PCI). As to the former, ASSENT-4 PCI trial did not find facilitated PCI improved the clinical outcomes. As to the later, clinical trials about routine use of thrombectomy or distal protection devices did not have consistent results, and even some of them revealed the association with the routine use of the devices and the outcome of increased infarct area. Besides, whether early invasive strategy is better than selective invasive strategy in patients with NSTE ACS was not confirmed in the 1-year follow-up of ICTUS trial. The long-term result might be essential to the final conclusion. Up to date, clinical evidence on the stem cell-based therapy in STEMI treatment did not show the consistent and robust improvement of left ventricular ejection fraction or other clinical outcomes, no matter with infusion route of bone marrow cells or with subcutaneous injection of granulocyte-colony stimulating factor. More knowledge of mechanism of stem cell-based therapy may be needed to make a significant progress. In addition to exhaustive efforts to put the advances in therapy for acute coronary syndrome into clinical practice, utilizing the advances in genomic medicine might be a critical step to achieve the ultimate treatment goal-modifying environmental and genetic risks to avoid irreversible myocardial damage.
Subjects
Acute coronary syndrome; Anticoagulant therapy; Antiplatelet therapy; Facilitated percutaneous coronary intervention; Genomic medicine; Stem cell-based therapy
SDGs
Other Subjects
abciximab; clopidogrel; dipeptidyl carboxypeptidase inhibitor; eptifibatide; fibrinogen receptor antagonist; fondaparinux; granulocyte colony stimulating factor; hirulog; hydroxymethylglutaryl coenzyme A reductase inhibitor; paclitaxel; rapamycin; tirofiban; acute coronary syndrome; acute heart infarction; article; bone marrow transplantation; clinical trial; coronary stent; drug eluting stent; heart infarction size; heart left ventricle ejection fraction; human; intermethod comparison; intervention study; invasive procedure; percutaneous coronary intervention; protective equipment; ST segment elevation; stem cell transplantation; thrombectomy; thrombus aspiration; treatment failure; treatment response
Type
journal article