The evaluation and management of acute coronary syndrome are undergoing rapid development and change. As the baby boomer generation ages, this syndrome is likely to become an even more prevalent and challenging clinical and socioeconomic problem. Further efforts to define its pathobiologic factors should lead to new and innovative detection and treatment options. A key factor in management will be the refinement and development of strategies to define and distinguish an intermediate-risk category of patients who need urgent admission and treatment, as opposed to those patients who can be expeditiously discharged to outpatient follow-up. Undoubtedly, the methodology used will differ according to local institutional expertise and experience, but it will include better clinical evaluation tools that incorporate electrocardiographic data, cardiac biomarkers, and complementary use of imaging technology.