Present and future of secondary prevention after an acute coronary syndrome.

Despite a marked improvement of in-hospital outcome of patients with Acute Coronary Syndrome (ACS), long-term outcome remains poor. There remains a high risk of complications, Non ST-Elevation ACS (NSTE-ACS) patients being at higher risk than those with ST-elevation ACS, in part due to more diffuse coronary artery disease. Whether with conservative medical management or an early invasive approach, of which they less frequently benefit, NSTE-ACS patients are less frequently treated according to guidelines. Therapeutic adhesion within the months following hospital discharge is low and associated with an increase in one-year mortality. The next step in the improvement of care of ACS patients will be to use multi-dimensional prevention programs that use didactic information tools and improve patient motivation, aimed at reinforcing the use of guidelines, promoting in-hospital therapeutic education, creating patient-health care provider partnerships and including discharge programs that ensure the prescription of recommended therapies.