Acute coronary syndrome is a leading cause for hospital admissions both in Europe and the United States resulting in high medical care expenses. During the past 25 years, there have been important advances in the therapeutic options for patients with an acute coronary syndrome with improved medical therapy and the introduction of percutaneous coronary intervention. However, despite the reduction of morbidity and mortality due to various refinements in medical treatment and technology, there are still opportunities to improve outcome in the first months after the event and on the longer run. Accurate recognition of patients that can benefit from additional therapies is, therefore, crucial in the therapeutic management of patients after an acute coronary syndrome.