Prof. Michael Haude,
In this highly educational session, four experts highlighted the most debated issues in the management of patients with ACS. Amir Lerman from Rochester, USA, elaborated the importance of different patient-, lesion-, and procedure-based parameters as predictors of mortality and MACE in these ACS patients. Although many of these parameters can be represented with the use of scores, these have not gained wide clinical acceptance compared to overall clinical judgment. Miles Dalby from Harefield, GB, addressed the very important question of whether patients with NSTEMI should receive an “ultrafast” invasive treatment comparable to the guideline-based treatment of STEMI. He highlighted that despite disappointing available data so far, there is a rationale for investigating a primary-PCI-like strategy in certain high-risk NSTEMI patients and that these patients are probably a small cohort of all NSTEMI patients. These high-risk patients are probably identified by clinical characteristics rather than by the rise of ischemia markers, which take some time to increase. He referred to the British DANCE pilot trial which evaluates such a treatment algorithm. Franz Weidinger from Vienna, Austria, reflected on antiplatelet therapy in ACS patients and referred to the guideline-based indications for Aspirin, Clopidogrel, Ticagrelor and Prasugrel. He concluded that the right choice of P2Y12 inhibitor for DAPT in ACS patients depends on individual risk stratification, taking into account ischemic and bleeding complications and dedicated contraindications for the different drugs. He recommended the assessment of certain bleeding risk scores to enhance an individualized treatment strategy. The duration of DAPT should be 12 months in ACS patients independent of the administered drug, although individual high-risk scenarios for thrombotic or bleeding events could require a shortening or prolongation of this time frame. Finally, Stefano Savonitto from Reggio Emilia, Italy, reported about specifics of ACS management in the elderly. This patient cohort is getting larger with the aging of the population mainly presenting with NSTE-ACS. Although primary PCI has be established as the treatment of choice also in elderly STEMI patients, in clinical practice this invasive treatment strategy is underrepresented in both STEMI and NSTEMI patients at higher age.
Burning issues in percutaneous coronary imaging for acute coronary syndromes
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