p.2 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

April 1, 2025 Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 e772

Methods: A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Structure: Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Key Words: AHA Scientific Statements ◼ acute coronary syndrome(s) ◼ angina, unstable ◼ anticoagulants ◼ aspirin ◼ atrial fibrillation ◼ cardiovascular diseases ◼ coronary artery disease ◼ coronary syndrome ◼ emergency medical services ◼ EMS ◼ fibrinolytic agents ◼ hemorrhage ◼ major adverse cardiovascular events ◼ morphine ◼ myocardial infarction ◼ non–ST-segment elevation myocardial infarction

◼ percutaneous coronary intervention ◼ prehospital ◼ revascularization ◼ risk ◼ ST-segment elevation myocardial infarction

◼ time factors ◼ treatment outcome

TABLE OF CONTENTS

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e771 Top Take-Home Messages. . . . . . . . . . . . . . . . . . . . . . . e773 Preamble. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e774 1.	 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e775 1.1. Methodology and Evidence Review. . . . . e775 1.2. Composition of the Writing Committee. . . . . . . . . . . . . . . . . . . . . . . . . . . . e776 1.3. Guideline Review and Approval. . . . . . . . . e776 1.4. Scope of the Guideline. . . . . . . . . . . . . . . . . e776 1.5. Class of Recommendation and Level of Evidence. . . . . . . . . . . . . . . . . . . . . . e777 1.6. Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . e778 2.	 Overview of ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . e779

2.1 Definition and Classification of ACS. . . . e779 3.	 Initial Evaluation and Management of

Suspected ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . e780 3.1. Initial Assessment of Suspected ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e780 3.1.1.	 Prehospital Assessment and

Management Considerations for Suspected ACS. . . . . . . . . . . . . e780 3.1.2.	 Initial In-Hospital Assessment of Patients With Confirmed or Suspected ACS. . . . . . . . . . . . . . . . e782 3.1.3.	 Risk Stratification Tools for

Patients With STEMI and NSTE-ACS. . . . . . . . . . . . . . . . . . . . e785 3.2. Management of Patients Presenting With Cardiac Arrest. . . . . . . . . . . . . . . . . . . . e786 4.	 Standard Medical Therapies for STEMI

and NSTE-ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e787 4.1. Oxygen Therapy. . . . . . . . . . . . . . . . . . . . . . . e787 4.2. Analgesics. . . . . . . . . . . . . . . . . . . . . . . . . . . . e787 4.3. Antiplatelet Therapy. . . . . . . . . . . . . . . . . . . e788 4.3.1.	 Aspirin. . . . . . . . . . . . . . . . . . . . . . . . . e788 4.3.2.	 Oral P2Y12 Inhibitors During

Hospitalization. . . . . . . . . . . . . . . . . e789 4.3.3.	 Intravenous P2Y12

Inhibition. . . . . . . . . . . . . . . . . . . . . . . e792 4.3.4 Intravenous Glycoprotein

IIb/IIIa Inhibitors. . . . . . . . . . . . . . . e793 4.4. Parenteral Anticoagulation. . . . . . . . . . . . . e794 4.5. Lipid Management. . . . . . . . . . . . . . . . . . . . . e797 4.6. Beta-Blocker Therapy. . . . . . . . . . . . . . . . . . e800 4.7. Renin-Angiotensin-Aldosterone System Inhibitors. . . . . . . . . . . . . . . . . . . . . . e800 5.	 STEMI Management: Reperfusion

Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e801 5.1. Regional Systems of STEMI Care. . . . . . . e801 5.2. Reperfusion at PCI-Capable Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e803 5.2.1.	 PPCI in STEMI. . . . . . . . . . . . . . . . . e803 5.2.2.	 Urgent CABG Surgery. . . . . . . . . . e804 5.3. Reperfusion at Non–PCI-Capable Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e804 5.3.1.	 Timing and Choice of Agent

for Fibrinolytic Therapy. . . . . . . . . e805 5.3.2.	 Coronary Angiography and

PCI After Fibrinolytic Therapy. . . . . . . . . . . . . . . . . . . . . . . . e806 6.	 NSTE-ACS: Routine Invasive or Selective Invasive Initial Approach. . . . . . . . . . . . . . . . . . . . . . e807 6.1. Rationale and Timing for a Routine Invasive or Selective Invasive Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . e807 7. Catheterization Laboratory Considerations in ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e810 7.1. Vascular Access Approach for PCI. . . . . . e810 7.2. Use of Aspiration Thrombectomy. . . . . . . e811 7.3. Use of Intracoronary Imaging. . . . . . . . . . . e811 7.4. Management of Multivessel CAD in ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e812 7.4.1. Management of Multivessel CAD in STEMI. . . . . . . . . . . . . . . . . e812 7.4.2. Management of Multivessel CAD in NSTE-ACS. . . . . . . . . . . . . e814 8.	 Cardiogenic Shock Management. . . . . . . . . . . . . e815

8.1. Revascularization in ACS With Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . e815

Downloaded from http://ahajournals.org by on October 7, 2026