State of the art: ACS treatment at the turn of the century

The pathophysiology of acute coronary syndromes is extremely complex. While thrombosis is known to be a major factor, the role of inflammation in the pathogenesis of these syndromes is becoming increasingly clear. As a result, simple linear pathways cannot accurately predict the impact of therapy. Patients with non-ST-segment elevation acute coronary syndromes are a heterogeneous group requiring immediate stabilization with antithrombotic therapy and full risk stratification. The initial electrocardiograph and serum concentrations of troponin-T and C-reactive protein have all been identified as independent risk markers with implications for both short- and long-term outcomes. Clinical trial data indicate that clinical management also has an impact on the short- and long-term risk of further events. Clinical practices should be evidence based; close attention to published guidelines reduces the incidence of subsequent events. As progressively more drugs and interventions are shown to be beneficial to patients with non-ST elevation acute coronary syndromes, clinical trials comparing combinations of therapies are urgently needed.

Duke Scholars

Author Robert M. Califf Medicine, Cardiology