title: How can we optimize the processes of care for acute coronary syndromes to improve outcomes?
abstract: Acute coronary syndromes (ACS), either ST-elevation myocardial infarction or non-ST-elevation ACS, are still one of the most common cardiac emergencies with substantial morbidity and mortality. The availability of evidence-based treatments, such as early and intense platelet inhibition and anticoagulation, and timely reperfusion and revascularization, has substantially improved outcomes in patients with ACS. The implementation of streamlined processes of care for patients with ST-elevation myocardial infarction and non-ST-elevation ACS over the last decade including both appropriate tools, especially cardiac troponin, for rapid diagnosis and risk stratification and for decision support, and the widespread availability of modern antithrombotic and interventional treatments, have reduced morbidity and mortality to unprecedented low levels. These changes in the process of care require a synchronized approach, and research using a team-based strategy and effective regional networks has allowed healthcare systems to provide modern treatments for most patients with ACS. There are still areas needing improvement, such as the delivery of care to people in rural areas or with delayed time to treatment.
authors.affiliation: Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: University of Utah, Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.affiliation: San Filippo Neri Hospital, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Tubaro
authors.affiliation: Research Institute IdiPaz, La Paz University Hospital, Madrid, Spain.
authors.forename: José Luis Lopez
authors.initials: JL
authors.lastname: Sendon
authors.affiliation: Duke Heart Center, Durham, NC.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: University of Freiburg, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: 3rd Department of Medicine, Cardiology, Wilhelminen Hospital, Hospital Association, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Bates
authors.affiliation: Thoraxcenter, Erasmus University, Rotterdam, the Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Département Hospitalo-Universitaire FIRE, Hôpital Bichat, AP-HP and Université Paris-Diderot, INSERM U-1148, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Duke Heart Center, Durham, NC. Electronic address: ohman001@mc.duke.edu.
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols; D042241:Early Diagnosis; D061345:Early Medical Intervention; D006297:Health Services Accessibility; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D058996:Quality Improvement; D012424:Rural Population; D061665:Time-to-Treatment
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors