Síndrome coronario agudo (Segunda parte)

Abstract

Acute ST myocardial infarction is usually secondary to the abrupt occlusion of a coronary artery, and its treatment isdirected to the urgent reperfusion of the affected vessel by means of thrombolytic therapy or angioplasty. In nonSTmyocardial infarction, the artery obstruction is severe, but not complete. In both cases the associated mechanism isa plaque rupture.  In patients with an initially normal electrocardiogram (ECG) and high suspicion of an acute coronary syndrome (ACS),serial ECG should be performed every 15 to 30 minutes. In these patients, markers of myocardial damage should bedetermined, choosing troponins when available, because of its ability to predict major cardiovascular events and toidentify patients who will benefit from a more aggressive therapy in the short to medium term.In acute ST myocardial infarction reperfusion should be initiated in the presence of pain and characteristic changes inthe ECG without waiting to the determination of myocardial enzymes. In this scenario the evaluation of the coronaryanatomy can be undertaken in an urgent fashion, before a primary angioplasty; after a failed thrombolytic therapy; orelectively after the occurrence of the event, at the onset of spontaneous or provoked ischemia. Non-ST myocardialinfarctions can be addressed with an "early invasive" or "medically conservative" strategies.