Defining the optimal pharmacotherapy of non-ST-segment elevation (NSTE) acute coronary syndromes (ACS): a rapidly moving target.

Acute coronary syndromes (ACS) represent a spectrum of disease, including unstable angina, non ST-elevation myocardial infarction, and ST-elevation myocardial infarction. In patients with cardiovascular disease, ACS represents the most common diagnosis for hospital admission, accounting for nearly 1.5 million hospital admissions in 1999. Similarly, although improvements in medical therapy have resulted in a dramatic decline in mortality from acute myocardial infarction (MI) over the last four decades, MI remains the most common cause of in-hospital death in industrialized nations. The approach to managing patients with acute coronary syndromes has evolved dramatically over the past decade and, in many respects, represents a rapidly moving target in light of recent advances in pharmacotherapy and catheter-based revascularization. A number of recently-published studies, including the TACTICS Trial, the ADMIRAL Trial, and the TARGET Trial, provide novel information about the relative merits of pharmacologic therapy and invasive intervention, A common theme from these studies is that there is a growing consensus among cardiologists that combination therapy with these two modalities may actually provide the best clinical outcomes in ACS patients.