2. Dr.Ali Eshraghi MD Interventional Cardiologist

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

4. 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

5.  Risk assessment is vitally important in admission and during hospitalization

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

7.  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

8.  Optimal Timing of intervention? Has not been clearly stablished

9.  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.

10.  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.

11.  Only culprit lsion intevention?

12.  Consider risk of contrast nephropathy