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Current Therapy for Acute Coronary Ischemia
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Harold L. Lazar; ed. 295 pages. Mount Kisco, New York: Futura Publishing; 1993. $65.00.
Although many available books review the management of acute myocardial ischemia, most focus on the medical management of acute ischemia or on interventional strategies. This book appears to be unique in that it comprehensively reviews treatment strategies for acute coronary insufficiency, including medical management (predominantly thrombolytic therapy) and interventional cardiologic and surgical techniques.
The book is, however, heavily weighted toward the surgical management of acute myocardial ischemia. Only 1 of the 11 chapters covers the role of thrombolytic therapy and other medical therapies for acute coronary ischemia. Of two chapters on interventional cardiologic techniques, one is devoted to the role of percutaneous transluminal coronary angioplasty (PTCA) for acute ischemic syndromes, whereas 6 chapters discuss surgical techniques and methods of myocardial protection during surgery. This difference may reflect the fact that the editor is a cardiothoracic surgeon.
The text does cover the pathophysiology of acute myocardial ischemia and succinctly details the experimental and clinical data supporting the currently accepted mechanisms for acute ischemic necrosis and benefit of reperfusion. Developments in the understanding of myocardial stunning and preconditioning are also discussed. Other current interventional techniques, including cardiac sinus interventions and methods used to reduce myocardial necrosis after failed PTCA or during surgery for acute ongoing myocardial ischemia, are also extensively covered in this book. The references for most chapters are extensive, and, surprisingly, abstracts are included in the references; the index is adequate.
The medical management of the acute myocardial ischemic syndromes, excluding thrombolytic therapy, is buried in chapters on surgical management of these same problems. For example, the medical management of unstable angina is not afforded a chapter of its own but is covered by a paragraph in "Surgical Revascularization for Refractory Unstable Angina." Another limitation of the book is the weight given to experience gained at the institution at which the authors practice. Detailed information is provided on the institutional experience of bypass surgery for failed PTCA, information based on data from 53 patients during an 8-year period. Although this is of interest, little weight is given to published studies that include more patients.
From the viewpoint of a clinical cardiologist, this book is informative about currently available modalities beyond medical management. However, it would be disappointing as a text for the medical management of unstable angina or non-Q-wave infarction. I also think that its appeal to the internist managing a patient with acute myocardial ischemia is limited. Overall, the authors use an interesting and unique approach that covers a broad spectrum of medical, interventional, and surgical management of acute myocardial ischemia. The book is fairly successful in meeting this goal.
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