Management of acute coronary syndrome: from primary health centre to tertiary hospital.

ABSTRACT

During the last decade there has been a revolutionary change in the management of acute coronary syndrome (ACS). Despite this, many patients die because of failure of reaching the hospital well in time and reluctance together with fear attached to commence aggressive pharmacological and catheter intervention on the part of the physicians. Aspirin, clopidogrel, low molecular weight heparin and fibrinolytic therapy can be safely commenced in primary health centre. Transport to the subdivisional or district hospital during the early stage of treatment even with ongoing fibrinolytic infusion is feasible, entails less risk and improves the survival. Prompt risk stratification of ACS patients is important for immediate revascularisation by angioplasty. Early percutaneous coronary intervention (PCI) of myocardial infarction with or without prior fibrinolytic therapy and for high risk ACS patient in a tertiary hospital remarkably improves the therapeutic outcome. For ACS time is muscle. So early and aggressive intervention right at the onset of symptom does improve the prognosis and save life.