Evidence for acute coronary syndrome (ACS) therapies

Antiplatelet therapy is the mainstay of treatment; aspirin (ISIS-2) and clopidogrel (CURE, COMMIT) improve mortality. Newer P2Y12 inhibitors improve mortality further (TRITON-TIMI-38, PLATO), but possibly not those conservatively managed (TRILOGY-ACS). GPIIbIIIa inhibitors have also shown benefit (CADILLAC) but are not typically used with bivalirudin (HORIZONS-AMI)

Anti-thrombotic therapy is beneficial and Fondaparinux is as effective as Enoxaparin but safer (OASIS-5). UFH is only necessary in PCI (ISIS-3, OASIS-6), but is still beneficial alongside fondaparinux (OASIS-6). UFH appears more efficacious and equally as safe as bivalirudin in the setting of PPCI (HEAT-PPCI), though bivalirudin is safer than UFH combined with glycoprotein inhibitor (HORIZONS-AMI)

Beta-blockers improve mortality (ISIS-1) but caution is needed in first 24 hours (COMMIT).

ACE inhibitors improve mortality after ACS (ISIS-4, GISSI-3), and Aldosterone antagonists are beneficial where LVF/CCF is present (EPHESUS).

PCI for STEMI is superior to thrombolysis, even when performed routinely after thrombolysis (NORDISTEMI). PCI is also beneficial in NSTEMI patients (TACTICS-TIMI-18, RITA-3).

Statins reduce recurrent cardiovascular events, with a trend emerging as early as 30 days (PROVE-IT). Other secondary prevention medications include Rivaroxaban (ATLAS-ACS-2-TIMI-51)