Confieso que he vivido

Abstract

After reading ReSCAR, (1) the interesting Registry on Acute Coronary Syndromes (ACS) carried out in centers of Argentina, a compendium of experiences gained in more than 40 years of treating and studying this clinical entity came to my mind. Over these years, several randomized and observational studies have been conducted (the latter were pioneered by resident physicians through the CONAREC registries), with the aim of addressing the different types of ACS. Despite the most specific diagnostic methods and advances in interventional and pharmacological therapies, my first thought is that every time I am dealing with a patient with ACS, I still have doubts about the optimal treatment. ACSs are a group of clinical entities with a high prevalence in the population and include different clinical conditions that have precordial pain in common. From my point of view, the greatest difficulty is not the diagnosis, but the categorization of each patient’s individual risk, since it is a clinical entity of erratic course and difficult to evaluate, because of a complex pathophysiological substrate. The ReSCAR registry provides detailed information on the entire broad spectrum of ACS, as opposed to previous registries that only focused on a single clinical presentation (unstable angina [UA], non-ST-elevation myocardial infarction [NSTEMI] or ST-elevation myocardial infarction [STEMI]). Ischemic heart disease is the leading cause of death in our country, and the factors that lead to it remain unchanged. In more than 20 years since the STRATEG-SIA registry, from 2001 to the present, the strong relationship between the lack of control of coronary risk factors and ACS (hypertension [HT] in more than 60% of patients, diabetes [DM] in more than 25%, dyslipidemia in more than 50%, current or past smoking in more than 40%) has been worryingly repeated. (2)