Highlights of the 2002 Update to the 2000 American College of Cardiology/American Heart Association Acute Coronary Syndrome Guidelines

Since the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for acute coronary syndrome (ACS) were published in 2000, a wealth of clinical evidence has accumulated. To incorporate this recent clinical data, an update to the 2000 ACC/AHA guidelines was issued in 2002. The revised ACC/AHA guidelines emphasize risk stratification of ACS patients to help guide therapy. In antiplatelet therapy, clopidogrel has gained a more prominent role in the treatment of ACS, both in breadth of patients and duration of treatment. Ticlopidine is no longer recommended. More guidance is provided with respect to specific glycoprotein IIb/IIIa inhibitor use in subgroups of ACS patients. In anticoagulation therapy, enoxaparin is now favored over unfractionated heparin. Finally, class I indications for an early invasive strategy have been expanded to include patients with elevated cardiac markers or new ST segment depression. Early initiation and continuation of a hepatic hydroxymethyl glutaryl coenzyme A reductase inhibitor is recommended if low-density lipoprotein cholesterol is higher than 100 mg/dL, and the addition of niacin or a fibrate is recommended in patients with isolated low high-density lipoprotein cholesterol. This article summarizes the major modifications to the ACS guidelines and highlights the clinical evidence prompting such changes.