Acute coronary syndrome update for hospitalists

Acute coronary syndromes (ACSs)--unstable angina, non-ST-segment (ST, part of an electrocardiogram between the QRS complex and the T wave) or ST-segment elevation myocardial infarction (MI)--remain extremely common and clinically challenging. In addition to electrocardiography and biomarkers, formal risk stratification using risk scores has become an important part of the initial evaluation of patients with ACS. On the basis of the estimated risk of subsequent ischemic events, the optimal use and timing of cardiac catheterization and revascularization procedures can be determined. Additionally, antiplatelet and anticoagulant therapy can be instituted, with consideration given to both the ischemic and bleeding risks in an individual patient. A particular challenge in ACS management has been the rapid evolution of guidelines in response to new randomized clinical trial and registry data. Understanding and implementing the recommendations in these evidence-based guidelines are important parts of hospitalists' practice.