The acute coronary syndrome (ACS) still remains a common disease in the preclinical as well as in the intrahospital emergency setting. Different clinical types of an ACS, such as unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) have to be differentiated diagnostically, prognostically and in terms of the best therapeutic strategy. Due to the broad and early use of percutaneous coronary intervention (PCI) as well as due to innovations in the antithrombotic and anticoagulation regime with the use of more effective P2Y12-receptor antagonists as well as the use of Fondaparinux and Bivalirudin, a continuous improvement of the prognosis and reduction of ischemic events could be achieved in ACS patients over the last few years. However, the increased bleeding rate, particularly when using those new substances, remains a relevant problem. Future studies are warranted to clarify if certain combinations of substances may be better suited to achieve the optimal balance between reduction of cardiovascular events on the one hand and bleeding risk on the other hand.
Georg Thieme Verlag Stuttgart.