Acute coronary syndromes: the reperfusion era and beyond

The recent decade has enjoyed and provided major advances in our understanding of the pathophysiology and treatment of patients with acute coronary syndromes. The use of reperfusion therapy and acute mechanical intervention in patients with acute myocardial infarction has dramatically advanced our understanding of the mechanisms of acute coronary events. The disrupted unstable plaque is the proximate cause of acute coronary syndrome in the majority of patients, most experiencing the plaque rupture of a lipid-laden lesion. This results in a spectrum of clinical disease with clinical presentations ranging from unstable angina to ST-elevation myocardial infarction. Although a common aetiology exists, treatment is not uniform. The triage of patients and risk stratification are paramount to selecting the appropriate therapy at the right time for individual patients.