New ESC 2023, ACS guidelines : “ STEMI merges with NSTEMI ” for some good reasons.

Is it a STEMI or Non -STEMI ? The apparently realistic dichotomous thinking about ACS among physicians has existed for quite a long time. However, since the underlying pathobiology being same , it is worth wondering whether the conventional bifurcation of ACS is fool -proof , when applied to management decsions. The rapidity and totality of plaque fissusre, rupture eruption,or erosion and the subsequent response of the local hemorheological system, determine the ferocity of the event. How to recognise all these deep intracellular events in bed side ? Unfortunately, still with a lot of gratitude, we have to rely on the humble ECG for early segregation of ACS ,initiation of treatment. (Truthfully, Waller, Einthoven and Lewis should still be celebrated as forefathers of ACS ) Though STEMI/NSTEMI show different faces of ACS, however, it makes little logic to have two big set of guidelines when a patient presents with ER with resting angina with variable ST/T changes* .(In the very early hours of ACS, ie just moments after biological trigger who can predict which patient will enter what path and evolve into STEMI or NSTEMI) * Typically, predicting the ECG-plaque interplay in Wellens’s syndrome ,De-winter or for that matter , in any biphasic precardial T wave sydromes can stretch our coronary acumen to its limits. Now, ESC 2023 task force hasrealised this .To bring bettter judgment with a open mind ,decided to merge STEMI/NSTEMI into a single guideline , of-c...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs