Initial treatment of acute coronary syndromes. Is there a future for MONA acronym after the 2010 guidelines

), nitrates and aspirin, have long beenthe preferred initial therapeutic measures for the emergency careof patients with acute coronary syndromes (ACS). The acronym‘MONA’ has been formed as a mnemonic of these therapeuticmodalities in training and everyday practice.Recently, several issues have emerged regarding treatment ofpatients with ACS according to MONA.In a retrospective analysis of the CRUSADE registry, morphineadministration in patients with ST-elevation myocardial infarc-tion (MI) was associated with increased rates of mortality and MI.It is unclear, however, whether this association reflects harmfuleffects ofmorphineoranother,unmeasured,treatmenteffect.Thusmorphine continues to be recommended for the relief of nitrate-refractory pain or pulmonary congestion in patients with ACS.