p.3 抽出テキスト

4.1.2. Healthcare systems and system delays .................................. 3743 4.1.3. Emergency medical services ....................................................... 3743 4.1.4. General practitioners .................................................................... 3744 4.1.5. Organization of ST-elevation myocardial infarction treatment in networks .............................................................................. 3744 4.2. Emergency care ....................................................................................... 3744 4.2.1. Initial diagnosis and monitoring ................................................ 3744 4.2.2. Acute pharmacotherapy .............................................................. 3744 4.2.2.1. Oxygen ....................................................................................... 3744 4.2.2.2. Nitrates ...................................................................................... 3744 4.2.2.3. Pain relief ................................................................................... 3744 4.2.2.4. Intravenous beta-blockers .................................................. 3744 5. Acute-phase management of patients with acute coronary syndrome .................................................................................................................. 3745

5.1. Selection of invasive strategy and reperfusion therapy ......... 3745 5.2. Acute coronary syndrome managed with invasive strategy 3745 5.2.1. Primary percutaneous coronary intervention strategy for ST-elevation myocardial infarction ...................................................... 3745 5.2.1.1. Invasive strategy in ST-elevation myocardial infarction late presenters ......................................................................................... 3747 5.2.2. Immediate invasive strategy for non-ST elevation acute coronary syndrome .................................................................................... 3747 5.2.3. Routine vs. selective invasive strategy .................................... 3747 5.2.3.1. Early vs. delayed invasive strategy for non-ST elevation acute coronary syndrome .............................................. 3747 5.2.4. Summary of invasive strategies for patients with non-ST elevation acute coronary syndrome ................................................... 3747 5.3. Fibrinolysis and pharmaco-invasive strategy in patients with ST-elevation myocardial infarction .......................................................... 3749 5.3.1. Benefit and indication of fibrinolysis ....................................... 3749 5.3.1.1. Pre-hospital fibrinolysis ........................................................ 3749 5.3.1.2. Angiography and percutaneous coronary intervention after fibrinolysis (pharmaco-invasive strategy) 3749 5.3.1.2.1. Comparison of fibrinolytic agents .......................... 3749 5.3.1.2.2. Hazards of fibrinolysis and contraindications .... 3749 5.4. Patients not undergoing reperfusion ............................................. 3749 5.4.1. Patients who are not candidates for invasive coronary angiography .................................................................................................... 3749 5.4.2. Patients with coronary artery disease not amenable to revascularization .......................................................................................... 3749 6. Antithrombotic therapy ................................................................................ 3750 6.1. Antiplatelet therapy in the acute phase ....................................... 3752 6.1.1. Oral antiplatelet therapy ............................................................. 3752 6.1.2. Timing of loading dose of oral antiplatelet therapy ......... 3753 6.1.2.1. Pre-treatment in patients with suspected STelevation myocardial infarction ........................................................ 3753 6.1.2.2. Pre-treatment in patients with non-ST-elevation acute coronary syndrome .................................................................. 3753 6.1.2.3. Summary of pre-treatment strategies ........................... 3753 6.1.3. Intravenous antiplatelet drugs ................................................... 3753 6.2. Anticoagulant treatment in the acute phase .............................. 3754 6.2.1. Anticoagulation in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention ................................................................................................... 3754 6.2.2. Anticoagulation in patients with non-ST-elevation acute coronary syndrome undergoing angiography and percutaneous coronary intervention if indicated ....................................................... 3754 6.3. Maintenance antithrombotic therapy after revascularization 3755 6.3.1. Shortening dual antiplatelet therapy ....................................... 3756 6.3.2. De-escalation from potent P2Y12 inhibitor to clopidogrel ..................................................................................................... 3756 6.3.3. Summary of alternative antiplatelet strategies to reduce bleeding risk in the first 12 months after acute coronary syndrome ........................................................................................................ 3757 6.4. Long-term treatment ............................................................................ 3759 6.4.1. Prolonging antithrombotic therapy beyond 12 months 3759 6.5. Antiplatelet therapy in patients requiring oral anticoagulation ................................................................................................. 3760 6.5.1. Acute coronary syndrome patients requiring anticoagulation ............................................................................................. 3760 6.5.2. Patients requiring vitamin K antagonists or undergoing coronary artery bypass surgery ............................................................ 3762 6.6. Antithrombotic therapy as an adjunct to fibrinolysis ............. 3762 6.7. Antithrombotic therapy in patients not undergoing reperfusion ......................................................................................................... 3762 7. Acute coronary syndrome with unstable presentation .................. 3762 7.1. Out-of-hospital cardiac arrest in acute coronary syndrome 3763 7.1.1. Systems of care ................................................................................ 3763 7.2. Cardiogenic shock complicating acute coronary syndrome 3763 8. Management of acute coronary syndrome during hospitalization 3764 8.1. Coronary care unit/intensive cardiac care unit ......................... 3764 8.1.1. Monitoring ......................................................................................... 3764 8.1.2. Ambulation ........................................................................................ 3764 8.1.3. Length of stay in the intensive cardiac care unit ............... 3765 8.2. In-hospital care ........................................................................................ 3765 8.2.1. Length of hospital stay ................................................................. 3765 8.2.2. Risk assessment ............................................................................... 3765 8.2.2.1. Clinical risk assessment ........................................................ 3765 8.2.2.2. Imaging risk assessment ....................................................... 3765 8.2.2.3. Biomarkers for risk assessment ....................................... 3765 8.2.2.4. Bleeding risk assessment ..................................................... 3765 8.2.2.5. Integrating ischaemic and bleeding risks ....................... 3765 9. Technical aspects of invasive strategies .................................................. 3766 9.1. Percutaneous coronary intervention ............................................. 3766 9.1.1. Vascular access ................................................................................ 3766 9.1.2. Intravascular imaging/physiology of the infarct-related artery ................................................................................................................ 3766

9.1.2.1. Intravascular imaging ............................................................. 3766 9.1.2.2. Intravascular physiology ....................................................... 3767 9.1.3. Timing of revascularization with percutaneous coronary intervention ................................................................................................... 3767 9.1.4. Balloons and stents ........................................................................ 3768 9.1.5. Embolic protection and microvascular salvage strategies 3768 9.1.5.1. Thrombus aspiration ............................................................ 3768 9.1.5.2. Interventions to protect the microcirculation .......... 3768 9.2. Coronary artery bypass grafting ...................................................... 3768 9.2.1. Indication and timing of coronary artery bypass grafting in acute coronary syndrome patients ..................................................... 3768 9.2.2. Technical considerations specific to acute coronary syndrome patients ...................................................................................... 3768 9.3. Spontaneous coronary artery dissection ..................................... 3768 9.3.1. Intravascular imaging ..................................................................... 3769 9.3.2. Revascularization ............................................................................. 3769 10. Management of patients with multivessel disease ........................... 3769 10.1. Management of multivessel disease in acute coronary syndrome complicated by cardiogenic shock ..................................... 3769 Downloaded from academic.oup.com/eurheartj/article/44/38/3720/7243210 by guest on 07 October 2026