Cardiovascular diseases are a leading cause of mortality and morbidity around the world. Coronary artery disease (CAD), commonly known as heart disease is the end product of atherosclerotic plaque formation. High blood pressure, smoking or high cholesterol levels are some of the risk factors that worsen the atherosclerotic condition. Stable angina and acute coronary artery syndrome (ACS) are the two main sub categories of clinical patterns produced by CAD. Coronary arteries that harden up due to the atherosclerosis limit the blood supply to the heart, thereby damaging the myocardial tissues (ischemia). Rupture of a vulnerable plaque causes occlusive intracoronary thrombus which further leads to the complete obstruction of blood supply, resulting in unstable angina or myocardial infarctions (heart attacks). Even though chest pain (angina) and discomfort are considered as the common symptoms of CAD, it is essential to perform the diagnostic procedures in order to distinguish patients with Acute Coronary artery syndrome. Prompt medical attention and diagnosis is crucial for treating the ACS patients as it is the major cause of infarctions.
Cardiac conditions with clinical patterns that represent myocardial infarctions and unstable angina fall into the category of ACS. Unstable angina, Non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) are the main classifications of ACS, diagnosed with the help of electrocardiograms (ECG) and blood tests. Devising a risk stratification method is possible only with in-vivo evaluation of the vulnerable plaque. Advanced medical imaging techniques such as intravascular ultrasound (IVUS), angioplasty surgery and optical coherence tomography (OCT) helps in assessing the pathophysiology of plaque formation, erosion and rupture. Treatment of acute coronary artery syndrome mainly involves medical therapy and revascularization procedures. Anti-ischemic agents, anti-platelet agents and anti coagulants are the standard pharmacological treatment options prescribed by physicians. Revascularization procedures include percutaneous coronary intervention (PCI) and Coronary Artery Bypass Graft (CABG). Fractional Flow Reserve guided percutaneous intervention helps the cardiologist determine whether to treat the lesions with stenting or medical therapy. The patient’s cardiac health, risk score and several other factors are taken into consideration to choose between and bypass and angioplasty surgery.
Huge advancements have been made in evaluating the extent and severity of culprit lesions of ACS which helps in the effective management of the condition. Novel antiplatelet drugs, pressure wire guided percutaneous interventions, fractional flow reserve and drug eluting stent implantations are some of the noteworthy achievements.
