Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Acute coronary syndrome (ACS) represents a significant global socioeconomic problem. In the United States, 6-7 million patients present to emergency service annually for chest pain or symptoms of ACS, the diagnosis of ACS being confirmed in 20-25% of these patients. There are two groups of ACS patients, with chest pain as the main and common the presentation that basically has the same pathophysiologic substrate. ⋯ It should be noted that history data, ECG findings and testing for cardiac markers are of particular importance in setting the diagnosis of ACS. Other useful methods of risk assessment include TIMI degree of risk, which is in general use because of its simplicity, but is less predictive, and the Pursuit and Frisco degree of risk. Regardless of the method used, it is recommended to determine the degree of risk for every patient on admission and at discharge.
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By establishing the Croatian network of primary PCI more patients can now be treated by this method every year. Nevertheless, therapeutic success depends on appropriate, i.e. complete antithrombotic therapy. On the other hand, about half of inhabitants of Croatia have not yet been covered with primary PCI network. ⋯ Heparin is an essential part of therapy for almost all acute coronary syndrome scenarios, but the role of low-molecular heparins is yet to be clarified. Fibrinolytic therapy still "saves lifes". By improving new fibrinolytics, they have become easier to use, entail less side effects and are more efficient.