p.2 抽出テキスト

Document Reviewers: Sigrun Halvorsen, (Clinical Practice Guidelines Review Co-ordinator) (Norway), Stefan James, (Clinical Practice Guidelines Review Co-ordinator) (Sweden), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Nina Ajmone Marsan (Netherlands), Sotiris Antoniou (United Kingdom), Riccardo Asteggiano (Italy), Maria Bäck (Sweden), Davide Capodanno (Italy), Ruben Casado-Arroyo (Belgium), Salvatore Cassese (Germany), Jelena Čelutkienė (Lithuania), Maja Cikes (Croatia), Jean-Philippe Collet (France), Gregory Ducrocq (France), Volkmar Falk (Germany), Laurent Fauchier (France), Tobias Geisler (Germany), Diana A. Gorog (United Kingdom), Lene Holmvang (Denmark), Tiny Jaarsma (Sweden), Hywel Wynne Jones (United Kingdom), Lars Køber (Denmark), Konstantinos C. Koskinas (Switzerland), Dipak Kotecha (United Kingdom), Konstantin A. Krychtiuk (Austria), Ulf Landmesser (Germany), George Lazaros (Greece), Basil S. Lewis (Israel), Bertil Lindahl (Sweden), Ales Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Mamas A. Mamas (United Kingdom), John William McEvoy (Ireland), Borislava Mihaylova (United Kingdom), Richard Mindham (United Kingdom), Christian Mueller (Switzerland), Lis Neubeck (United Kingdom), Josef Niebauer (Austria), Jens Cosedis Nielsen (Denmark), Alexander Niessner (Austria), Valeria Paradies (Netherlands), Agnes A. Pasquet (Belgium), Steffen E. Petersen (United Kingdom), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Bianca Rocca (Italy), Giuseppe M.C. Rosano (Italy), Leyla Elif Sade (United States of America / Türkiye), François Schiele (France), Jolanta M. Siller-Matula (Austria), Christian Sticherling (Switzerland), Robert F. Storey (United Kingdom), Matthias Thielmann (Germany), Christiaan Vrints (Belgium), Stephan Windecker (Switzerland), Rune Wiseth (Norway), and Adam Witkowski (Poland)

All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the guidelines. The report is also available on the ESC website www.escardio.org/Guidelines

See the European Heart Journal online for supplementary documents that include background information and evidence tables.

Keywords Guidelines • Acute cardiac care • Acute coronary syndrome • Antithrombotic therapy • Fibrinolysis • Highsensitivity troponin • Invasive strategy • MINOCA • Myocardial infarction • Non-ST-elevation myocardial infarction • Patient-centred care • Percutaneous coronary intervention • Recommendations • Reperfusion therapy • Revascularization • Secondary prevention • ST-segment elevation myocardial infarction • Unstable angina

Table of contents

1. Preamble .............................................................................................................. 3727 2. Introduction ....................................................................................................... 3728 2.1. Definitions | Acute coronary syndromes and myocardial infarction ............................................................................................................. 3730 2.2. Epidemiology of acute coronary syndromes .............................. 3732 2.3. Number and breakdown of classes of recommendations ... 3732 2.4. What is new ............................................................................................. 3733 3. Triage and diagnosis ........................................................................................ 3735 3.1. Clinical presentation and physical examination ......................... 3735 3.1.1. Clinical presentation ...................................................................... 3735 3.1.2. History taking and physical examination .............................. 3737 3.2. Diagnostic tools | Electrocardiogram ............................................ 3737 3.2.1. Acute coronary syndrome with persistent ST-segment elevation (suspected ST-elevation myocardial infarction) ......... 3738 3.2.2. Acute coronary syndrome without persistent STsegment elevation (non-ST elevation acute coronary syndrome) ...................................................................................................... 3738 3.3. Diagnostic tools | Biomarkers ........................................................... 3739 3.3.1. High-sensitivity cardiac troponins ............................................ 3739 3.3.2. Central laboratory vs. point of care ....................................... 3739 3.3.3. Confounders of cardiac troponin concentration ............. 3739 3.3.4. Rapid ‘rule-in’ and ‘rule-out’ algorithms ................................ 3739 3.3.4.1. European Society of Cardiology 0 h/1 h and 0 h/2 h algorithms .................................................................................................. 3740 3.3.4.1.1. Rule-out ............................................................................. 3740 3.3.4.1.2. Rule-in ................................................................................ 3740 3.3.4.1.3. Observe ............................................................................. 3740 3.3.4.2. Practical guidance on how to implement the European Society of Cardiology 0 h/1 h algorithm ................. 3742 3.3.5. Other biomarkers .......................................................................... 3742 3.4. Diagnostic tools | Non-invasive imaging ....................................... 3742 3.4.1. Echocardiography ........................................................................... 3742 3.4.2. Computed tomography ............................................................... 3742 3.4.3. Cardiac magnetic resonance imaging with or without stress testing ................................................................................................. 3742 3.5. Differential diagnosis for acute chest pain .................................. 3743 4. Initial measures for patients presenting with suspected acute coronary syndrome | Initial treatment ........................................................ 3743

4.1. Pre-hospital logistics of care .............................................................. 3743 4.1.1. Time to treatment ......................................................................... 3743

ESC Guidelines                                                                                                                                                                                          3721

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