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Acute coronary syndrome is a life-threatening disease that occurs acutely and severely and is one of the leading causes of mortality in Thailand. It is a crisis that causes sudden death in patients. However, community hospitals can reduce the loss of patients’ lives through treatments with a thrombolytic drug. The purposes of this report were to study the prognosis, treatment plans and nursing care and to compare the differences between 2 patients with acute coronary syndrome in a case study. A case study was conducted on two specific cases. All data were collected between May 2020 and June 2021. The study of 2 patients with acute coronary syndrome found that the first case, aged 64 years, came in with the symptom of chest pain radiated to the jaws and the left arm with sweating and cold body 20 minutes before arriving at the hospital. He had a history of high cholesterol but has not been taking medication for more than 7 months. This patient was administered intravenous thrombolytic drug, but the complication of low blood pressure occurred. The doctor therefore considered adjusting the treatment plan and prescribed all 5 nursing care programs. At follow up, successful reperfusion was confirmed. The second case, aged 47 years, came in with the symptom of chest compression radiated to the left arm 1 hour before arriving at the hospital. He had a history of coronary artery disease, high cholesterol, high blood pressure and lack of medication. He had a comorbidity of smoking, stress, and obesity. The patient received intravenous thrombolytic drug and all 5 nursing care programs. At follow up, successful reperfusion was confirmed with no sign of complications. With regards to the patient care of acute coronary syndrome, nurses play a vital role in correctly and quickly evaluating and screening the patients starting from their arrival at the hospital until their transfer to another hospital. Consequently, the patients are correctly diagnosed and can quickly receive the treatment with a thrombolytic drug. Nurses must also have the knowledge of the management of drugs and must constantly monitor for any abnormality that may occur in patients to increase their survival rate.