Anti-inflammatory treatment of acute coronary syndromes

The past decade has seen a steady growth in the treatment options available for Acute Coronary Syndromes (ACS), as a consequence of our better understanding of ACS pathophysiology. Administration of fibrinolytics in ST-elevation myocardial infarction, and of potent antiplatelet and anticoagulant drugs in all ACS, has allowed us to considerably improve their outcome. Yet, the rate of adverse cardiac events at early follow-up ranges from 15% to 20%. Thus, to further improve the outcome of ACS or to prevent their occurrence, it is important to identify new therapeutic target. A number of experimental and clinical studies have highlighted the key role of inflammation in all phases of atherosclerosis, from fatty streaks to disrupted plaques and raised levels of inflammatory markers have been associated to a poor outcome despite optimal treatment, including myocardial revascularization. In this review, we will focus on inflammation as a possible new therapeutic target of ACS, discussing the anti-inflammatory treatments in four sections: 1) non specific anti-inflammatory drugs; 2) specific antagonists of key cytokines; 3) immunomodulatory therapies; 4) immunization as promising therapeutic modality against atherosclerosis.