Treatment of acute coronary syndromes: have we reached the ceiling?
Lars Wallentin
This article has no abstract so we have provided the first paragraph of the full text.
Non-ST elevation acute coronary syndrome (ACS) is currently the most common reason for admission to coronary care units. For roughly the past 15 years, combined platelet inhibition and coagulation activation has been a mainstay of treatment. In the 1980s, the first-generation antithrombotic drugs—aspirin and intravenous unfractionated heparin—halved event rates compared with placebo. In the 1990s, use of the second-generation platelet inhibitory agents, glycoprotein IIb/IIIa inhibitors and oral clopidogrel, further reduced event rates by 20–30%. Subcutaneous low-molecular-weight heparin also proved at least as effective as unfractionated heparin, and was simpler to use. Finally, several prospective randomized trials have demonstrated that, in addition to these antithrombotic medications, routine early coronary angiography and, if appropriate, revascularization reduces mortality and morbidity and improves quality of life without added costs.
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