Dr.Ali Eshraghi MD Interventional Cardiologist

Non STE ACS  Angiographic Findings: 34% 3VD 28%2VD 26%SVD 10%LMCAD Culprit lesion charactristic: eccentric,scalloped,evidence of thrombus,haziness

Non STE ACS  I) an early invasive strategy: involving routine early cardiac catheterization followed by PCI, CABG,or continuing medical therapy, depending on the coronary anatomy  (2) a more conservative approach: initial medical management and catheterization reserved for patients with recurrent ischemia either at rest or on a noninvasive stress test

 Risk assessment is vitally important in admission and during hospitalization

Early invasive stretegy  Hemodynamic instability  Severe LV dysfunction/overt CHF  Recurrent rest angina  Mechanical complication  Significant electrical instability

 Early invasive strategy is recommended in patients with UA/NSTEMI who have : *ST-segment changes * positive troponin * recurrent ischemia *within 6 months of a prior PC(Restenosis?) * In prior CABG

 Optimal Timing of intervention? Has not been clearly stablished

 Optimal medical therapy and antiPLT and antithrombotic are important  GP lIb/lIla inhibitors or a thienopyridine (clopidogrel or prasugrel) improves both acute and long-term outcomes after PCI.

 GP lIb/lIla inhibitors are most important for NonSTE ACS and: DM +ive TnI ST changes GP lIb/lIla inhibitors may be used before cath. Or during cath.

 Only culprit lsion intevention?

 Consider risk of contrast nephropathy