Acute coronary syndromes without ST elevation

In the last decade, acute coronary syndromes without ST elevation (ACS ST-) have become a clinical entity encompassing previous technologies such as acute coronary insufficiency and non-Q wave myocardial infarction. The recognition of its risks and, above all, the development and adaptation of medical and interventional strategies have transformed the prognosis. Patients presenting with ACS ST- are not all identical and do not all have the same prognosis; based on this observation, a number of prognostic scores have been proposed which help decide whether to use drugs such as GP IIb/IIIa inhibitors or coronary angioplasty. Conservative and aggressive strategies are opposing choices but risk stratification allows the treating physician to take a safe decision in the majority of cases. Besides angioplasty and GP IIb/IIIa inhibitors, the basic treatment (aspirin, low molecular weight heparin, clopidogrel, betablockers) should of course be prescribed and its efficacy has contributed to a better outcome in these patients. The recommendations of the scientific societies have evolved with time and increased understanding, allowing an evidence-based approach to the management of ACS ST- patients.