Acute Coronary Syndrome – A Clinical Update and Review

Tóm tắt

Background: Acute coronary syndrome continues to pose a major global mortality burden. Many studies have sought to classify and define its major etiology and pathophysiology. This review discusses the definition, classification, etiologies, diagnostic criteria, and differential diagnostic methods, as well as the newest updates in management strategies for each ACS subtype.

Main: This review separates acute coronary syndrome into subgroups based on etiology and pathogenesis, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), unstable angina, and newer subtypes such as type 2 MI and myocardial infarction with non-obstructive coronary arteries (MINOCA). Management strategies differ for each group: timely reperfusion is emphasized for STEMI, early invasive therapy for high-risk NSTEMI, and evidence-based pharmacotherapy, including dual antiplatelet therapy, high-intensity statins, and renin–angiotensin system inhibitors is indicated for all type of ACS. Secondary prevention through cardiac rehabilitation and lifestyle modification remains essential.

Findings: Evidence highlights the importance of early recognition, especially in patients with atypical presentations such as the elderly, women, and individuals with diabetes. Guideline-directed therapies and revascularization have shown to reduce mortality even though complications including arrhythmias, cardiogenic shock, and heart failure persist. Emerging therapies—such as PCSK9 inhibitors, anti-inflammatory agents, and digital health tools—offer promise in reducing residual risk.

Conclusion: Acute coronary syndrome continues to account for a significant proportion of morbidity and mortality worldwide despite advances in diagnosis and treatment. Recognition of subtypes such as type 2 MI and MINOCA has refined management, while early diagnosis, reperfusion, and secondary prevention remain central to
improving outcomes. Ongoing challenges highlight the need for precision medicine, novel therapies, and integrated long-term strategies.