Coronary revascularization in patients with acute coronary syndromes

Non-Q wave myocardial infarction and unstable angina remain major causes of morbidity and mortality in patients with atherosclerotic coronary artery d isease. Judicious use of cardiac catheterization and coronary revasculariza tion may further improve the prognosis of patients with these acute coronar y syndromes (ACS). Patients with ACS at high risk for further cardiac event s include those patients with electrocardiographic ST-segment depression, l eft bundle branch block, and, to a lesser extent, T-wave inversion, and tho se patients with recurrent pain, cardiac enzyme elevation, or exercise-indu ced ischemia after hospitalization. While these patient subgroups may benef it from early cardiac catheterization and revascularization, the role of ro utine coronary revascularization is less well established.;Whereas one stud y has demonstrated reduced recurrent hospitalizations in patients treated w ith routine invasive strategy, another has suggested that outcomes are not different with the two approaches. Pending the results of a third ongoing s tudy - the Thrombolysis in Myocardial Infarction (TIMI)-18 trial - a judici ous approach to revascularization in patients presenting with ACS is warran ted.