Acute coronary syndromes: assessing risk and choosing optimal pharmacological regimens for a superior outcome

Revolutionary strategies for management of acute coronary syndromes (ACSs) have been introduced over the past 15 years. Such innovations have occurred in the area of interventional cardiology (bare metal evolving to drug-eluting stents) as well as in pharmaco-therapy, particularly anti-platelet therapy. Agents including clopidogrel and glycoprotein IIb/IIIa receptor inhibitors have been developed, as adjuncts to aspirin, in order to better target the elevated platelet activity central to the thrombus that underlies ACS. Most importantly, there has been a greater emphasis placed upon a patient's risk for ischaemic complications when determining the overall management strategy including timing of angiography and medications. In the effort to improve outcomes for the most high-risk patients, there has been a continued focus on the development of newer therapies. Research has shown, however, that achieving clinical benefit may not require the formulation of the next generation of anti-platelet agent but may require a more astute awareness of patient risk, and the selection of management strategies that demonstrate the greatest benefit to them.