Secondary prevention in Acute Coronary Syndrome (ACS)

Patients with acute coronary syndrome (ACS) are still prone to recurrent ischemic events, especially in the first months after the episode of ACS. In addition, myocardial injury caused by episodes of ACS can cause complications in the next months and years and cause new events such as arrhythmia, sudden cardiac death, heart failure, mural thrombosis, and systemic thromboembolism. In recent decades, our understanding of the pathophysiology of vascular events has improved leading to new therapeutic and preventive strategies to prevent death, stroke, and recurrent vascular events. These secondary prevention methods focus on two goals: 1) vascular protection and reduction of ACS recurrence; 2) cardiac protection and reduction of ventricular remodeling and its consequences. These objectives are followed by the following interventions: lifestyle modifications (e.g. smoking cessation, increasing physical activity, use of healthy diet), cardiac rehabilitation, treating psychiatric disorders, treating of high blood pressure, glycemic control, modification of lipid profile (i.e. use of statins), antiplatelet therapy (i.e. aspirin and one of P2Y12 inhibitors), renin angiotensin system inhibition (i.e. ACE inhibitors, ARBs, aldosterone antagonists), use of beta adrenergic blockers, and probably use of direct oral anticoagulants, and if indicated, use of devices such as Permanent Pace Maker (PPM), Implantable Cardioverter Defibrillator (ICD) and/or Cardiac Resynchronization Therapy (CRT). These evidence-based recommendations for secondary prevention of ACS usually underuse in clinical practice in many regions of the world.