Current approaches to patients with acute coronary syndromes

The approach to patients with acute coronary syndrome continues to evolve as knowledge regarding underlying pathophysiology and treatment strategies grows. Current medical and invasive therapy for acute coronary syndromes targets the thrombus formation on the ruptured atherosclerotic plaque. There are clear indications for therapies such as aspirin, unfractionated and LMWHs in unstable angina and NSTEMI, GpIIb/IIIa receptor inhibitors in unstable angina or NSTEMI when PCI or stent is performed, and thrombolytics in STEMI. The use of GpIIb/IIIa receptor inhibitors in the setting of unstable angina or NSTEMI without PCI or stent is reserved for patients with moderate to high risk. Furthermore, studies comparing invasive versus conservative management in acute coronary syndromes did not all give similar results. It is clear that additional studies are needed to define the role of GpIIb/IIIa receptor inhibitors in unstable angina or NSTEMI when PCI or stents are not used. Additional studies are also needed to define the role of invasive versus conservative management in unstable angina or NSTEMI more clearly. Future directions may also involve understanding the role of matrix metalloproteinases in the pathophysiology of the acute coronary syndromes. This understanding may then lead to additional therapies for the acute coronary syndromes.