Risk stratification and the management of non-ST-segment elevation acute coronary syndromes: the role of antiplatelet therapy.

Risk stratification is crucial in guiding the acute management of non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). An early invasive strategy (catheterization/revascularization) in conjunction with aggressive antiplatelet and anticoagulant therapy offers the most effective means of reducing ischemic complications in intermediate- and high-risk patients. In low-risk patients, stress testing serves to indicate whether a secondary prevention strategy or elective catheterization/percutaneous coronary intervention and GP IIb/IIIa inhibition is more appropriate. NSTE ACS also confers a long-term risk of recurrent cardiovascular events, regardless of whether initial management follows a medical or interventional approach. Combination aspirin and clopidogrel therapy is effective for secondary prevention across the spectrum of NSTE ACS patients, regardless of risk or initial treatment strategy (conservative or invasive). Long-term aspirin and clopidogrel therapy addresses the thrombotic component of atherothrombosis, while combined beta-blocker, ACE inhibitor, and statin therapy is directed against the atheroma.