EDITORIAL

Revascularisation for acute coronary syndromes: PCI or CABG?

J Gunn¹, D P Taggart²

¹ Cardiovascular Research Group, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
² Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford, UK

Correspondence to:
Correspondence to:
Dr Julian Gunn, Cardiovascular Research Group, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, UK;
j.gunn@sheffield.ac.uk

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Recent advances in both percutaneous coronary intervention and coronary artery bypass grafting emphasise the need for new randomised trials addressing acute coronary syndromes specifically, including a high proportion of patients with truly representative disease

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Keywords: acute coronary syndromes; percutaneous coronary intervention; coronary artery bypass grafting

Abbreviations: ACS, acute coronary syndrome; ARTS, arterial revascularization therapies study; AWESOME, angina with extremely serious operative mortality evaluation; CABG, coronary artery bypass grafting; ERACI-II, Argentine randomised study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease; FRISC-II, Fragmin and fast revascularization during instability in coronary artery disease; NSTEMI, non-ST segment elevation myocardial infarction; OPCABG, "Off-pump" CABG; PCI, percutaneous coronary intervention; PRAIS-UK, prospective registry of acute ischaemic syndromes in the UK; RAVEL, randomised comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization; RITA-3, third randomized intervention trial of unstable angina; SIRIUS, prospective randomised evaluation of the sirolimus-eluting stent in patients with de novo coronary artery lesions; SoS, stent or surgery trial; STEMI, ST segment elevation myocardial infarction; TACTICS-TIMI 18, treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction

The first 150 words of the full text of this article appear below.

We are in the midst of a steady increase in the number of patients presenting to hospitals with acute coronary syndromes (ACS). This group includes patients with ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina (chest pain without electrocardiographic changes or an enzyme rise). The optimal treatment of STEMI (currently thought to be primary percutaneous coronary intervention (PCI) or systemic thrombolysis) will not be discussed further here. For NSTEMI and unstable angina, the consensus of rapidly evolving guidelines is that management should be based upon a system of risk stratification, incorporating an assessment of chest pain, ECG changes and cardiac markers.¹ For patients in the high risk group, recent trials show that an early invasive strategy (coronary angiography followed by revascularisation when appropriate) is superior to a conservative one, in terms of recurrent ischaemic episodes, if not lives saved.^2–4 We are now left . . . [Full text of this article]

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