Acute coronary syndromes spectrum

Murphy SA, Gibson CM, Morrow DA, et al. Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum a meta-analysis. Eur Heart J 2007 28(17) 2077-86. 

Acute coronary syndromes (ACS) encompass a wide spectrum of coronary artery disease from unstable angina (UA) to myocardial infarction (MI). According to the 2007 report from the American Heart Associations and Stroke Statistics Committee, about 700,000 Americans are expected to suffer from their first MI yearly, with almost 500,000 recurrent Mis occurring annually (1). Coronary heart disease (CHD) is responsible for about one out of every five deaths in the United States ACS is the cause of over 1.5 million hospitalizations yearly and therefore plays a significant role in the cost of our health care. 

Antiplatelets are the mainstay of treatment for acute coronary syndrome (ACS), a spectrum of ischemic events that include myocardial infarction and unstable angina, with well-established benefit in preventing atherothrombosis. Results of a meta-analysis of 145 clinical studies reported a 25% reduction of atherothrombotic events in high-risk patients treated with antiplatelet therapy [12]. Another meta-analysis of 109 clinical trials has concluded that antiplatelet medications were able to reduce transient ischemic attacks and strokes by 22%, reduce coronary artery disease by 29%, and reduce peripheral artery disease by 23% [13]. Table 19.1 summarizes the major commercially available antiplatelet agents. 

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