[Modern treatment in acute coronary syndrome]

The "acute coronary syndrome" (ACS) is a life threatening condition. In patients with ST-segment elevation myocardial infarction (STEMI) an immediate reperfusion therapy is indicated. Primary percutaneous coronary intervention (PCI) is the gold standard. In ACS without ST-segment elevation (NSTE-ACS) coronary angiography should be performed within 72 hours in patients with risk factors. Depending on the coronary anatomy treatment options are PCI, aorto-coronary bypass surgery or sole medical therapy. The antiplatelet therapy has a key role in ACS. In addition to acetylsalicylic acid (ASA) another platelet aggregation inhibitor should be given for 12 months. For the majority of patients ticagrelor and prasugrel are the agents of first choice, because both act faster and stronger than clopidogrel. In patients at high risk of bleeding clopidogrel remains the preferable antiplatelet agent. In addition to antiplatelet treatment anticoagulant therapy is necessary in ACS-patients.