Presenter | see Discussant report
Gilles Montalescot (France)
Discussant | see Presenter abstract
Christian Hamm, FESC (Germany)
In patients with acute coronary syndromes undergoing coronary angiography main stem lesions are found in approximately 5% of the cases. The treatment decision in this high risk subset is regularly difficult, because surgery in developing myocardial infarction is problematic and angioplasty technically demanding. Evidence for treatment decisions in such scenarios cannot be derived from randomised trials, but must come from carefully conducted registries.
In this context, the GRACE data provide valuable information for the management of these patients. It is self explaining that the mortality is high and the confounding factors are too complex to make conclusions with respect to the best treatment modality. The decision making has to be very individual and depends also on the local expertise and circumstances.
There is a strong trend over the observation period of 7 years to acutely perform more angioplasties and to delay surgery to following days. Therefore, these data reassure of what is currently done across the world and support the use of revascularisation techniques whatever and whenever feasible.