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Acute coronary syndromes (ACS) encompass a spectrum of conditions that include patients presenting with recent changes in clinical symptoms or signs, with or without changes on 12-lead electrocardiogram (ECG) and with or without acute elevations in cardiac troponin (cTn) concentrations. Patients presenting with suspected ACS may eventually receive a diagnosis of acute myocardial infarction (AMI) or unstable angina (UA). The diagnosis of myocardial infarction (MI) is associated with cTn release and is made based on the fourth universal definition of MI.UA is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. It is characterized by specific clinical findings of prolonged (>20 min) angina at rest; new onset of severe angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of MI. ACS are associated with a broad range of clinical presentations, from patients who are symptom free at presentation to patients with ongoing chest discomfort/symptoms and patients with cardiac arrest, electrical/haemodynamic instability, or cardiogenic shock (CS).
The focus of this guideline is largely centred on the management of patients who will eventually receive a diagnosis of Type 1 MI. However, at every stage of the management of patients presenting with ACS, physicians must carefully consider other differential diagnoses in their clinical assessment because they are common, associated with different underlying pathological mechanisms, have different prognoses, and frequently require different treatment approaches. More information is provided in the Supplementary data online. In general, detailed information regarding the results of individual trials will not be provided in the main guideline. However, where appropriate, this information is provided in the Supplementary data online evidence tables.
