The Year in Cardiology 2018: Acute Coronary Syndromes

Petr Widimsky; Filippo Crea; Ronald K. Binder; Thomas F. Lüscher

Disclosures

Eur Heart J. 2019;40(3):271-282. 

In This Article

What's Next

What is the next frontier? The biggest unmet need is effective management of patients presenting with cardiogenic shock or after being resuscitated because of sudden cardiac death. Indeed, mortality had not changed over the last decade and is still in the range of 40–60% at 1 year,[71] while those presenting in stable conditions enjoy a survival rate of up to 98% in-hospital and 90% at 1 year (Figure 1). What should be done to reduce mortality in this patient population? The first minutes after cardiac arrest are the most crucial ones. Everybody should master cardiopulmonary resuscitation in order to prevent irreversible neurological damage—and here we have to fill an educational gap within the population at large. Then, the door-to-balloon-time should be shortened further by fast tracks in the hospitals. Third, percutaneous pumps and assist devices are novel tools to overcome the acute haemodynamic problems, unload the left ventricle, avoid multiorgan damage, and potentially allow for recovery of pump function. However, the intra-aortic balloon pump proved ineffective and the Impella and extracorporeal membrane oxygenation remains to be tested properly. Forth, novel anti-inflammatory strategies,[72] as recently documented in the CANTOS Trial[73] might help to reduce infarct size and facilitate haemodynamic recovery. And finally, there is still hope that stem cell therapies might assist in regenerating the heart muscle after an infarction in the future, once we will find the right way to reactivate regenerative pathways as is possible in fish and amphibia.[74–77]

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