Burden of disease: medical and economic impact of acute coronary syndromes.

Despite advances in treatment, acute coronary syndromes (ACS), which consist mainly of ST-segment elevation myocardial infarction (STEMI) and unstable angina (UA)/non-STEMI (NSTEMI), present an enormous medical, social, and economic burden worldwide. According to public databases, 879 000 patients were discharged from US hospitals with a diagnosis of ACS in 2003. Globally, ACS in the form of myocardial infarction are responsible for almost half of all deaths related to cardiovascular disease. One third of STEMI patients die within 24 hours of onset, and about 15% of UA/NSTEMI patients will die or experience reinfarction within 30 days. ACS also exact a high toll in terms of treatment-related and indirect economic costs. Direct medical costs of ACS are estimated at $75 billion, with a significant portion going toward drug therapy and associated costs. Data from clinical trials indicate that a management strategy including antithrombotic therapy can reduce ACS-related morbidity and mortality and related costs. More recently developed antithrombotic agents may have clinical and economic advantages over older therapies.