Percutaneous coronary intervention guidelines:: new aspects for the interventional treatment of acute coronary syndromes

In March 2005, the European Society of Cardiology (ESC) guidelines on percutaneous coronary intervention (PCI) were published, in which the management of patients with acute coronary syndromes (ACSs) was presented in detail for the interventional cardiologist. These guidelines supplement previous guidelines from the ESC on ACS with and without ST-elevation. Patients presenting with non-ST-segment elevation ACS should be treated according to the risk of progressing to myocardial infarction (MI) or death. Immediate (< 2.5 h) or early (< 48 h) coronary angiography and PCI are advised, particularly in patients with elevated troponin levels or diabetes mellitus. Coronary intervention in high-risk patients should be performed with triple antiplatelet therapy (aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors). In patients with ST-segment elevation MI, primary PCI is the preferred treatment option, particularly > 3 h after onset of clinical symptoms. Adjunctive therapy should include abciximab. Patients treated with thrombolysis should undergo invasive evaluation within 24 h. If this cannot be achieved, ischaemia-driven angiography is recommended.