Role of coronary angiography in acute coronary artery syndromes
Our understanding of the acute coronary syndromes continues to evolve. The dynamic nature of the atherosclerotic plaque has caused us to rethink the role that coronary angiography plays in defining CAD. It is now clear that many patients with "insignificant" disease are actually quite vulnerable to an acute MI. Despite the problems with radiographic images of the coronary lumen in this disease process, the role coronary angiography has to play in the treatment of those with either STEMI or UA/NSTEMI is actually growing. More information than simply the lesion diameter stenosis can be derived from the angiogram, including lesion morphology, epicardial flow, and myocardial perfusion. These characteristics seem to describe physiology that has prognostic importance. As the clinical trials addressing therapy for the acute coronary syndromes emerge, it is becoming more clear that angiography and percutaneous coronary intervention will play an ever greater role in treatment. The implications for the health care system as the widespread use of coronary angiography becomes the standard are not insignificant.
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