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"Stent 4 Life" Targeting PCI at all who will benefit the most A joint project between EAPCI, Euro-PCR, EUCOMED and the ESC Working Group on Acute Cardiac Care

Publikace na 3. lékařská fakulta |
2009

Tento text není v aktuálním jazyce dostupný. Zobrazuje se verze "en".Abstrakt

Progress in pharmacological therapy and secondary prevention has improved the prognosis of patients with chronic, stable coronary artery disease (CAD). Indeed many previous trials as well as the recently published Courage study have confirmed that the natural course of coronary patients is generally good, with low annual mortality rates (10% mortality rate) that will last for several months, until the disease enters again a period of a more stable course.

In patients with stable CAD, benefit of mechanical revascularisation using bypass surgery or stented angioplasty will be restricted to symptomatic improvement, unless a large proportion of the myocardium is at risk (10% or more) and can be revascularised. On the contrary, there is mounting evidence that myocardial revascularisation in patients presenting with acute forms of CAD is life saving: it reduces mortality, rates of non-fatal reinfarction and stroke, as compared to the previous standard of care (pharmacological treatment, including thrombolytic therapy for STEMI).

This evidence has led all ESC as well as international Practice Guidelines to issue class I A recommendations for revascularisation of STEMI, non-STEMI-acute coronary syndrome and other high-risk unstable angina subsets.1,2 As a result, common sense would dictate that resources are prioritised in order to target PCI to those patients presenting with the above mentioned disease subsets who will benefit the most from revascularisation therapies. While up to 85% of all PCI procedures performed in the United States in 2004 were still done to treat stable forms of chronic CAD, the practice has evolved and already today, treatment of acute coronary syndromes represents over 50% of the PCI case load in many European countries and abroad.

Providing this service to the population is part of our essential responsibilities as a professional group and the public is entitled to expect this level of quality-of-care, across boundaries. At the same time, focusing human and financial resources on the treatment of acute coronary syndromes is rewarding from many perspectives: it provides tremendous added value to the practice of PCI, both for the public and and the physicians, while health care payers will enjoy the high return on investment.