[Anti-anginal medication in management of acute coronary syndrome]

Pharmacological therapy for acute coronary syndrome (ACS) is divided into the treatment for myocardial ischemia and that for coronary thrombosis. Immediate nitrates(sublingual tablets and sprays) are used to alleviate attacks and patients not responding them are treated by intravenously in 24 hours. The initial treatment for non-ST-segment elevation myocardial infarction(NSTEMI) with the administration of nitrates and beta blocker is judged as Class I (evidence level B) by ACC/AHA classification. Administering beta blocker in patients with ACS has reduced the progression to myocardial infarction by 13%. Ca antagonist is administered in patients for whom nitrates and/or beta blocker are contraindicated or in whom myocardial ischemia persists or frequently relapses in spite of the treatment with an adequate dose of the drugs. Since recent studies have suggested that ACS may not result from a local vascular stenosis, but from coronary inflammation, treating the local vascular lesion alone with PCI is not enough. Rather, pharmacological therapy is important to reduce overall patient risk, thereby suppressing the progress of atherosclerosis.