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2023 ESC Guidelines for the management

of acute coronary syndromes

Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)

Authors/Task Force Members: Robert A. Byrne  *†, (Chairperson) (Ireland), Xavier Rossello ‡, (Task Force Co-ordinator) (Spain), J.J. Coughlan ‡, (Task Force Co-ordinator) (Ireland), Emanuele Barbato (Italy), Colin Berry (United Kingdom), Alaide Chieffo (Italy), Marc J. Claeys (Belgium), Gheorghe-Andrei Dan (Romania), Marc R. Dweck (United Kingdom), Mary Galbraith (United Kingdom), Martine Gilard (France), Lynne Hinterbuchner (Austria), Ewa A. Jankowska (Poland), Peter Jüni (United Kingdom), Takeshi Kimura (Japan), Vijay Kunadian (United Kingdom), Margret Leosdottir (Sweden), Roberto Lorusso (Netherlands), Roberto F.E. Pedretti (Italy), Angelos G. Rigopoulos (Greece), Maria Rubini Gimenez (Germany), Holger Thiele (Germany), Pascal Vranckx (Belgium), Sven Wassmann (Germany), Nanette Kass Wenger (United States of America), Borja Ibanez  *†, (Chairperson) (Spain), and ESC Scientific Document Group

* Corresponding authors: Robert A. Byrne, Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland, and School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland. Tel: +353-1-2483190, E-mail: robertabyrne@rcsi.ie; and Borja Ibanez, Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain, and Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain, CIBERCV, ISCIII, Madrid, Spain. Tel: +3491 4531200, E-mail: bibanez@cnic.es † The two Chairpersons contributed equally to the document and are joint corresponding authors. ‡ The two Task Force Co-ordinators contributed equally to the document. Author/Task Force Member affiliations are listed in author information. ESC Clinical Practice Guidelines (CPG) Committee: listed in the Appendix. ESC subspecialty communities having participated in the development of this document: Associations: Association of Cardiovascular Nursing & Allied Professions (ACNAP), Association for Acute CardioVascular Care (ACVC), European Association of Cardiovascular Imaging (EACVI), European Association of Preventive Cardiology (EAPC), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), and Heart Failure Association (HFA). Working Groups: Cardiovascular Pharmacotherapy, Cardiovascular Surgery, E-Cardiology, Myocardial and Pericardial Diseases, Thrombosis. Patient Forum The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal, and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oup.com). Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. This article is co-published with permission in European Heart Journal and European Heart Journal - Acute Cardiovascular Care. All rights reserved. © The European Society of Cardiology 2023. The articles are identical except for stylistic differences in keeping with each journal’s style. Either citation can be used when citing this article. For permissions, please e-mail: journals.permissions@oup.com No part of this publication may be reproduced, stored in a retrieval system, transmitted, used for text and data mining, or used for training artificial intelligence, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license or under terms agreed with the appropriate reprographics rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. ESC Guidelines are protected by copyright. As per opt out option under Article 4 §3 of EU Directive 2019/790, the European Society of Cardiology (ESC) reserves all rights to license uses of ESC Guidelines to train or develop generative artificial intelligence (AI) models, large language models or other deep learning or machine learning models.

European Heart Journal (2023) 44, 3720–3826 https://doi.org/10.1093/eurheartj/ehad191

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