Book Review

Current Therapy for Acute Coronary Ischemia

N Engl J Med 1994; 330:1322May 5, 1994

Article

Current Therapy for Acute Coronary Ischemia
Edited by Harold L. Lazar. 295 pp., illustrated. Mount Kisco, N.Y., Futura, 1993. $65. ISBN: 0-87993-555-3

The past few decades have witnessed revolutionary developments in the management of ischemic heart disease. Technical advances in coronary revascularization and myocardial protection, clinical refinement of thrombolytic therapy, and the introduction of mechanical assist devices and cardiac transplantation have substantially improved the care of patients with acute coronary ischemic syndrome. Nevertheless, acute coronary ischemia remains the primary cause of death in industrialized countries. More than ever, close collaboration among cardiologists, cardiac surgeons, cardiac anesthesiologists, and basic researchers is crucial to the treatment of this important clinical entity. This attractive book succinctly summarizes events of the past two decades in the treatment of acute coronary ischemic syndrome. It contains 11 chapters and covers a variety of important topics in the management of acute coronary ischemia, with greatest emphasis on surgical interventions.

In most sections, the scope and size of the book limit the depth of coverage. Nonetheless, the authors do a fine job of reviewing the topics in a concise and readable fashion. The introductory chapter on the pathophysiology of reversible and irreversible myocardial injury is clinically focused and quite well written. Some landmark data, such as findings from the Thrombolysis in Myocardial Infarction and Thrombolysis and Angioplasty in Myocardial Infarction trials, are only superficially covered in the chapter on thrombolytic therapy. Those who are extensively involved in this area may find this chapter too general. Coronary-sinus interventions are given special consideration in one particularly informative chapter. However, the clinical usefulness of these emerging techniques remains to be seen. The general principles of percutaneous transluminal coronary angioplasty in acute coronary ischemic syndrome are nicely summarized in another chapter, but there is no discussion of new devices.

Several chapters are devoted to descriptions of myocardial-protection techniques used during acute myocardial ischemia in a variety of surgical settings. The authors' personal experiences will be valuable to readers. The surgeon's role in the management of refractory unstable angina and acute myocardial infarction is clearly described and placed in historical perspective, although the details are somewhat sketchy. The last two chapters discuss mechanical support systems and issues concerning the mechanical bridge to transplantation for acute coronary ischemia. Anyone interested in interventional cardiology will find these chapters very practical and intelligible.

The book contains a highly useful summary of current knowledge and a discussion of some future directions. The editor is to be commended for nicely integrating the various focuses of this multiauthored textbook with minimal duplication. Because of the lag time inherent in the publication process, information about the most recent developments is not included. The references are up to date and extensive. The black-and-white illustrations and tables are informative, well designed, and clear. This book will be particularly welcomed by cardiologists, cardiovascular surgeons, and cardiac anesthesiologists who seek a quick general review of the subject. There is no doubt that it will also be a valuable reference for residents and fellows in cardiology and cardiovascular surgery.

Won R. Lee, M.D.
Samsung Medical Center, Seoul, Korea 135-230