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Acute coronary syndromes: a success story but still a long way to go
  1. James A Shaw1,2
  1. 1 Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr James A Shaw, Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC 3004, Australia; J.Shaw{at}alfred.org.au

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Increased understanding of the pathophysiology of cardiovascular (CV) disease over the last 50 years has resulted in significant improvement in patient outcomes. Between 1970 and 2015 the age-standardised death rates from coronary artery disease have reduced by nearly 70% in Western countries (figure 1). This impressive reduction in CV mortality has been a result of numerous facets of medical research. These include a better understanding of the role of cholesterol in plaque formation and progression,1 the discovery of safe and highly effective lipid-lowering therapy namely statins,2 more aggressive blood pressure targets made possible with well-tolerated medications,3 better public health programmes including aggressive antismoking campaigns,4 and improving patient awareness of the importance of presenting early to the emergency department with chest pain. Finally, technology has also contributed with the widespread availability of percutaneous coronary revascularisation, which can now be performed safely and quickly with excellent short-term and long-term results. This has been particularly beneficial in patients presenting with ST elevation myocardial infarction (STEMI).

Figure 1

The figure demonstrates the reduction in age-standardised mortality rates for coronary artery disease in the UK between 1979 and 2013.8 The corresponding major advancements in cardiovascular preventative and therapeutic strategies and the year at which they were instituted into practice are shown on the x-axis. AICD, automatic implantable cardioverter defibrillator; PCI, percutaneous coronary intervention; PCSK-9 Proprotein Convertase Subtilisin Kexin Type 9, STEMI, ST segment elevation myocardial infarction.

The majority of these advances occurred between 1990 and 2005, and while progress continues to be made in reducing the incidence of patients presenting with acute coronary syndrome (ACS) and improving their outcomes the rate of improvement has slowed. The paper by Wang et al 5 published in Heart reports …

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