[The necessity for a differentiated approach to the treatment of acute disorders of the coronary circulation].

The article discusses problems of the tactics of treatment of acute disorders of coronary circulation with the use of radiologically-guided intravascular and surgical methods along with drug therapy. The authors conclude on the basis of accumulated experience that in most patients, both in unstable angina pectoris and in acute myocardial infarction, there is no need for emergency procedures and operations for direct revascularization of the myocardium, which should be resorted to only in patients with complete irresponsiveness to drug therapy. After stabilization of the condition, however, the tactics of diagnostic and therapeutic measures must be differentiated according to the patients' clinical condition and a series of laboratory indices. In particular, treatment should be limited to drugs in patients with an uneventful clinical course and high tolerance to physical exertion (bicycle ergometry test). Patients who are relatively irresponsive to drug therapy or have a low tolerance to physical exercises should be subjected to planned selective coronarography and, if indicated, treated by transluminal angioplasty of the coronary arteries or by an operation for direct revascularization of the myocardium. The authors emphasize in particular that the methods of drug, radiologically-guided intravascular, and surgical treatment should not be regarded as alternatives but as methods mutually complementing one another in different stages of the disease.