Coping with new challenges in acute coronary syndromes.

The acute coronary syndromes have become well-established clinical entities and are used as working diagnoses tied in with elaborate investigation and treatment practice guidelines. However, these syndromes remain challenging because their prevalence, morbidity and mortality remain high. Furthermore, these syndromes are demanding on the health care system because an early invasive management strategy is recommended for most patients with these conditions. Coping with these challenges requires the following initiatives: stepping beyond current diagnostic and management algorithms to a better performing risk stratification scheme that considers specific patient risk factors in addition to the disease risk, and a reintegration of acute coronary syndromes into the more global perspective of coronary artery disease; more effective antithrombotic therapy that does not further compromise bleeding risk, or drugs that control thrombogenic stimuli; and medical and revascularization therapies targeted to more specific individual pathophysiologies identified by novel blood markers and imaging techniques.