PCI in modern cardiology: a shift from chronic stable patients to acute coronary syndromes.

Natural course of Chronic stable angina is generally good and also there are no culprit lesions to treat. hence PCI does not improve prognosis. On the other hand PCI can improve prognosis in Acute coronary syndromes because culprit lesion can be identified.PCI centers should fcus on treating acute coronary syndromes. Want to know more about COURAGE and MASS II trails you can click here.

Lessons to be learned

* PCI centers should focus its resources (both human and financial) mainly on the treatment of acute coronary syndromes, where PCI was clearly shown to improve the patients outcomes
* Patients with chronic stable coronary artery disease should be initially treated medically and PCI should be performed upon patient’s request (when medical therapy failed) to aleviate the symptoms (patients should be informed, that PCI will not prolong their life in this setting)
* The proportion of acute / elective PCI cases can be used to evaluate the effectivity of health care systems (regional, national, local): PCI for acute coronary syndromes should exceed 50% of all PCI workload (probably should be around 60-70%) in a modern PCI center.
* Bypass surgery remains a viable alternative for chronic stable patients with multivessel coronary artery disease.