Acute coronary syndromes (ACSs) are among the leading causes of death in the developed world and are associated with annual costs of $300 million in the United States alone.1,2  In 2005, approximately 1.5 million patients were discharged from the hospital with a primary or secondary diagnosis of ACS. Overall, morbidity and mortality rates have decreased in patients with ACS, but 25% of patients are still not receiving guideline-recommended care, a factor that causes substantial preventable in-hospital mortality. This lack of care is thought to occur primarily because hospitals do not follow quality improvement programs.3–5 

ACS is almost always associated with reduced or disrupted blood flow to a major coronary artery. This disruption is usually associated with the presence of a thrombus, or blood clot, which begins at the site of injury in the vessel wall....

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