Over the past 2 years, multiple clinical trials have reported results that will influence the treatment of patients with non-ST-segment elevation acute coronary syndromes (ACS) for many years to come. However, large-scale clinical trials take years to complete, during which time the underlying landscape may shift. Thus, while clinical trials provide baseline information to help physicians make evidence-based decisions regarding patient care, trials must be interpreted in the context of current treatment guidelines and practices. In addition, regulatory and advisory board decisions, case reports, clinician experience, and patient factors have a clear but difficult-to-measure impact on practice patterns. In recognition of the wide range of information affecting physicians' decision-making processes in patients with ACS, a roundtable was convened on June 5, 2009, in New York City to discuss the implications of recent data for clinical practice. Eight clinicians from the disciplines of cardiology and emergency medicine shared information and opinions on recent advances in antiplatelet treatment, clinical trial results, guidelines, and other issues related to patient care. This article is derived from transcripts of their presentations and the surrounding discussions at this meeting, with the intent of reporting both quantitative information on recent advances in the management of ACS and qualitative information and opinions from participants. Each author held primary responsibility for the writing and editing of his or her section, and participated in the editing of the entire manuscript.