[Pathogenesis and treatment of acute coronary syndromes].

Acute coronary syndromes (ACS) include unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Acute coronary syndromes lead to important epidemiological and economical problems. In polish population an estimated incidence of ACS is 250 000 cases per year. 30-day mortality in UA/NSTEMI is approximately 3.5%, and 8.4% in STEMI. The atherosclerotic plaque instability with subsequent rupture and thrombus formation is a primary mechanism of ACS. Plaque destabilization is evoked by local and systemic inflammation. The primary risk factors in ACS are: age > 65 years, diabetes, peripheral artery disease, stroke, previous myocardial infarction and elevated levels of cardiac troponins. The guidelines for treatment of ACS are based on the results of large randomized clinical trials assessing the reduction of relevant clinical end-points (death, AMI, recurrent ischaemia). The goal of treatment of UA/NSTEMI is the stabilization of the plaque, prevention and reduction of myocardial ischaemia and AMI. Inefficient medical treatment and sustained symptoms are the indication for coronary angiography and percutaneous coronary intervention (PCI). The main goal of treatment in STEMI is quick regaining of the culprit vessel patency and maintaining of sufficient myocardial perfusion. It can be done by thrombolytic therapy or primary coronary angioplasty. In comparison to fibrynolysis PCI confers the lower risk of death and recurrent AMI. New regimens of pharmacological treatment (facilitated PCI) including the half-dose of fibrynolytic and GPIIbIIIa inhibitor prior to PCI are assessed to improve the efficiency of PCI.