Medical Treatment of Coronary Artery Disease / 한양의대학술지

ABSTRACT

Coronary heart disease is still highly prevalent worldwide and remains a common cause of mortality. The underlying cause responsible for stable angina is chronic atherosclerotic narrowing of the coronary artery. Most patients with stable angina can be managed with medical treatment with aspirin, beta-blocker, calcium channel blocker (CCB), and nitrate. High-risk patients with previous myocardial infarction (MI), left ventricular dysfunction, and diabetes mellitus should be considered for angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARB) and aggressive statin treatment. Acute coronary syndromes (ACS) are the clinical spectrum that includes unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Because the atherosclerotic plaque instability with subsequent rupture and thrombus formation is a primary mechanism of ACS, antiplatelet and antithrombotic agents are essential for the prevention of coronary events. Combination treatment with antiplatelet agents (aspirin, clopidogrel and cilostazol) and anticoagulants, such as unfractionated heparin and low-molecular-weight heparins (LMWH), provides improved efficacy for the secondary prevention of ACS. The main goal of treatment in STEMI is quick recovery of the culprit vessel patency and maintaining sufficient myocardial perfusion. It can be done by thrombolytic therapy or primary coronary angioplasty.