Percutaneous Coronary Intervention in Managing Acute Coronary Syndromes

Damage of the heart muscles due to inadequate blood flow or oxygenation is known as myocardial ischemia. The condition becomes worse in some cases, resulting in myocardial infarctions (heart attacks) or unstable angina. Atherosclerotic plaque build up in the coronary arteries is the main cause of restriction in the blood supply. Termed as Coronary Artery Disease (CAD) or coronary heart disease, this condition has been a leading cause of mortality and morbidity. CAD can lead to acute coronary syndrome (ACS), a condition characterised by the signs and symptoms compatible with myocardial infarctions (MI) and unstable angina (UA). The spectrum of ACS clinical presentation covers a range from UA to non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). In a nutshell, ACS is associated with the sudden and unexpected rupture of a vulnerable plaque followed by the partial or complete blockage of a stenotic artery. Reperfusion therapy is recommended for ACS patients on an immediate basis. Aggressive medical therapy or non-invasive percutaneous coronary intervention is performed to restore the blood flow to the heart.

Either a combination of anti-ischemic and antithrombotic agents or a non-invasive percutaneous coronary intervention is preferred for treating UA and NSTEMI patients. Accurate diagnosis and prompt revascularization procedures are crucial in devising the management strategy of ACS. Guide-wire based Fractional Flow Reserve (FFR) has become an indispensable tool for the interventional procedures. In-vivo evaluation of the vulnerable plaque and the well-validated cut off value offered by  FFR measurements, guides the ACS treatment. To help choose between drug therapy and revascularization procedure, Guide-wire based fractional flow reserve helps the interventional cardiologist to make a decision.

Although PCI has bbeen considered the safest way to reduce complications related with MI and ACS, some findings reported the occurrence of cardiac arrhythmias among patients undergoing the percutaneous procedure. Irregularity in the heart beat or rhythm leads to twitching of atria and desynchronised contractions of heart chambers, thereby increasing the risk of stroke and heart failure. Insertion of a medical Atrial Fibrillation Pacemaker provides a solution to help prevent adverse clinical conditions and outcomes. Hooked up to the heart with tiny wires, an artificial medical atrial fibrillation pacemaker reduces the risk of complications. Appropriate management of arrhythmia is crucial to improve clinical outcomes.

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Fractional Flow Reserve Measurements in the Management of Acute Coronary Artery Syndrome

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. 

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