Last Updated 16 November 2015
Acute coronary syndrome (ACS)—an umbrella term that encompasses acute ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA)—is a leading cause of morbidity and mortality in the developed world. ACS is usually the outcome of atherosclerosis in the coronary arteries with concomitant endothelial dysfunction, followed by plaque disruption and thrombin formation. Despite ongoing improvements in ACS management, rates of reinfarction and death are high, and a pressing need remains for new antithrombotic and antiatherosclerotic therapies that can reduce ischemic complications and mortality in both the acute and the posthospital settings.

Questions Answered in This Report:

  • Eli Lilly/Daiichi Sankyo’s prasugrel (Effient/Efient) and AstraZeneca’s ticagrelor (Brilinta/Brilique) are adenosine diphosphate (ADP) receptor antagonists that are more potent, consistent, and faster-acting than clopidogrel (Bristol-Myers Squibb/Sanofi’s Plavix/Iscover, generics). What are thought leaders’ opinions of these agents? In the era of generic clopidogrel, how are thought leaders using these agents?

  • Since its launch, The Medicines Company’s bivalirudin (Angiomax/Angiox) has enjoyed significant uptake in the United States at the expense of the glycoprotein (gp) IIb/IIIa inhibitors and unfractionated heparin (UH) in the ACS acute setting. However, sales of the branded drug will be severely constricted by conflicting clinical trial data calling into question the clinical utility and cost-effectiveness of bivalirudin as well as by the launch of generics beginning in 2015. What are thought leaders’ opinions of the recent clinical trial data? What effect will the entry of generic bivalirudin have on the anticoagulant market in the ACS acute setting?

  • A wide array of add-on therapies are expected to launch in the ACS 12-month posthospital setting between 2014 and 2024. Such therapies use diverse treatment approaches, ranging from more-aggressive management of lipid levels to targeting inflammatory pathways that are thought to contribute to the pathogenesis of ACS. For which treatment strategies do experts express the most enthusiasm? What level of market penetration can we expect of new therapies given the increasingly crowded and competitive landscape?

  • The last 18 months have seen the approval of two novel antiplatelet agents: cangrelor (The Medicines Company’s Kengreal/Kengrexal), an IV ADP receptor antagonist for patients undergoing PCI in the acute setting, and vorapaxar (Merck’s Zontivity), a thrombin receptor antagonist for secondary prevention. How do thought leaders view these two novel agents? In which patients do thought leaders plan to use these agents?


Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan.

Primary research: 20 country-specific interviews with thought leaders.

Epidemiology: Number of diagnosed STEMI events, NSTEMI events, and UA events; number of prevalent ACS cases in the first 12 months following an ACS event.

Population segments in market forecast: STEMI patients, NSTEMI/UA patients in acute ACS setting, and ACS patients in posthospital, chronic setting.

Emerging therapies: Phase II: 15 drugs; Phase III: 8 drugs; preregistration: 0 drugs; registered: 0 drugs. Coverage of 4 select preclinical and Phase I products.