New directions for pharmacotherapy in the treatment of acute coronary syndrome

Expert Opin Pharmacother. 2016 Dec;17(17):2291-2306. doi: 10.1080/14656566.2016.1241234. Epub 2016 Oct 10.


Acute coronary syndromes (ACS) are one of the leading causes of death worldwide. Several landmark trials, followed by a widespread introduction of new agents, have significantly improved ACS outcomes in recent years. However, despite the use of contemporary therapy, a substantial number of ACS patients continue to suffer from cardiovascular events. Areas covered: The aim of this review was to summarize available data on innovative drugs and pharmacological strategies that have potential to amend the current ACS therapy. We present the results of recent large clinical trials, as well as insights from ongoing phase III and phase IV studies, exploring the value of new strategies for the improvement of outcomes in ACS. Expert opinion: More potent platelet inhibition, more profound lipid reduction and possibly anti-inflammatory action are considered to have potential to further reduce the rates of adverse cardiovascular and thrombotic events in ACS patients. 'Hit fast, hit hard' approach regarding novel antiplatelet and lipid-lowering therapy seems attractive, but it has to be considered that these strategies may be associated with increased adverse events rate. Introduction of cangrelor and ezetimibe, and potentially future recognition of proprotein convertase subtilisin/kexin type 9 antibodies, are likely to alter the landscape of ACS pharmacotherapy.

Keywords: Acute coronary syndrome; CETP inhibitors; P2Y12 receptor inhibitor pre-treatment; PCSK-9 antibodies; cangrelor; ezetimibe; losmapimod; myocardial infarction; pain management.

Publication types

  • Review

MeSH terms

  • Acute Coronary Syndrome / blood
  • Acute Coronary Syndrome / drug therapy*
  • Acute Coronary Syndrome / metabolism
  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Antibodies, Monoclonal / therapeutic use*
  • Anticholesteremic Agents / therapeutic use*
  • Clinical Trials as Topic
  • Drug Discovery
  • Ezetimibe / therapeutic use
  • Humans
  • PCSK9 Inhibitors
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Purinergic P2Y Receptor Antagonists / therapeutic use*
  • Thrombosis / drug therapy
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Anticholesteremic Agents
  • PCSK9 Inhibitors
  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • Adenosine Monophosphate
  • cangrelor
  • PCSK9 protein, human
  • Ezetimibe