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Acute coronary syndromes (ACS) include unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). The management of ACS has improved greatly over the last 3 decades, with an associated steady decline in mortality from this condition seen in the US. The benefits of advances in the management of ACS observed in the US have not fully extended to Mexico, as thrombolytic therapy remains the most commonly used reperfusion strategy for STEMI and new antithrombotic drugs are not widely available. However, treatment of ACS in Mexico is rapidly evolving. Dual oral antiplatelet therapy with the combination of clopidogrel and aspirin (acetylsalicylic acid) is becoming the new standard of care for the management of patients with NSTEMI and those undergoing percutaneous coronary intervention. Results from controlled clinical studies strongly support the use of early and aggressive treatment with this combination. The addition of clopidogrel to the national formulary represents an important step in the evolution of care for ACS patients in Mexico. Local and regional leadership is required to foster the widespread adoption of this highly beneficial treatment strategy. The main objectives of this review are to highlight the recommendations of the Mexican guidelines for the management of ACS and provide some perspective regarding challenges to optimal management of ACS patients in Mexico.