A fundamental role of cell adhesion molecules are implicated for the disease process of acute coronary syndromes. Among adhesion molecules, platelet membrane glycoprotein Ib binds to the von Willebrand factor and thereby activates glycoprotein IIb/IIIa, resulting in platelet aggregation. P-selection is rapidly translocated onto the cell surface within minutes and adheres to a sialylated fucosylated carbohydrate structure, sialyl Lewis(x), on leukocytes. P-selectin mediates adhesion of leukocytes to the activated platelets. Thus, these platelet glycoproteins play a active role in cell-extracellular matrix interaction and cell-cell interaction at the first step of the thrombus formation at the culprit lesion of the coronary artery. The more comprehensive understandings of adhesion molecules and their functions may promote the more effective therapeutic strategies for the acute coronary syndromes.