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Recommendation Table 16 — Recommendations for long-term management ............................................................................................................ 3787 Recommendation Table 17 — Recommendations for patient perspectives in acute coronary syndrome care ....................................... 3791

List of tables

Table 1 Classes of recommendations .......................................................... 3728 Table 2 Levels of evidence ................................................................................ 3728 Table 3 Definitions of terms related to invasive strategy and reperfusion therapy commonly used in this document ....................... 3731 Table 4 New recommendations .................................................................... 3733 Table 5 Revised recommendations ............................................................... 3734 Table 6 Dose regimen of antiplatelet and anticoagulant drugs in acute coronary syndrome patients ............................................................... 3751 Table 7 Suggested strategies to reduce bleeding risk related to percutaneous coronary intervention ............................................................ 3760 Table 8 Gaps in evidence .................................................................................. 3793 Table 9 ‘What to do’ and ‘What not to do’ ............................................. 3796

List of figures

Figure 1 Central illustration .............................................................................. 3729 Figure 2 The spectrum of clinical presentations, electrocardiographic findings, and high-sensitivity cardiac troponin levels in patients with acute coronary syndrome ................................................................................. 3730 Figure 3 Classification of patients presenting with suspected acute coronary syndrome: from a working to a final diagnosis .................... 3732 Figure 4 An overview of the initial triage, management and investigation of patients who present with signs and symptoms potentially consistent with acute coronary syndrome ......................... 3736 Figure 5 The A.C.S. assessment for the initial evaluation of patients with suspected acute coronary syndrome ................................................. 3737 Figure 6 The 0 h/1 h or 0 h/2 h rule-out and rule-in algorithms using high-sensitivity cardiac troponin assays in patients presenting to the emergency department with suspected NSTEMI and without an indication for immediate invasive angiography ......................................... 3741 Figure 7 Modes of presentation and pathways to invasive management and myocardial revascularization in patients presenting with STEMI .............................................................................................................. 3746 Figure 8 Selection of invasive strategy and reperfusion therapy in patients presenting with NSTE-ACS ............................................................ 3748 Figure 9 Antithrombotic treatments in acute coronary syndrome: pharmacological targets ...................................................................................... 3752 Figure 10 Recommended default antithrombotic therapy regimens in acute coronary syndrome patients without an indication for oral anticoagulation ....................................................................................................... 3755 Figure 11 Alternative antiplatelet strategies to reduce bleeding risk in the first 12 months after an ACS .................................................................. 3757 Figure 12 Antithrombotic regimens in patients with acute coronary syndrome and an indication for oral anticoagulation ................................ 3761 Figure 13 A practical algorithm to guide intravascular imaging in acute coronary syndrome patients ............................................................... 3767 Figure 14 Algorithm for the management of acute coronary syndrome patients with multivessel coronary artery disease ............ 3770 Figure 15 Underlying causes for patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries ......... 3773 Figure 16 Evaluation of patients with a working diagnosis of MINOCA .................................................................................................................. 3774 Figure 17 Long-term management after acute coronary syndrome 3782 Figure 18 Lipid-lowering therapy in ACS patients .................................. 3785 Figure 19 A person-centred approach to the ACS journey .............. 3789 Figure 20 Acute coronary syndrome patient expectations ................ 3790

Abbreviations and acronyms

AβYSS Beta Blocker Interruption After Uncomplicated Myocardial Infarction ACCOAST A Comparison of Prasugrel at the Time of Percutaneous Coronary Intervention or as Pretreatment at the Time of Diagnosis in Patients with Non-ST Elevation Myocardial Infarction ACE Angiotensin-converting enzyme ACS Acute coronary syndrome AF Atrial fibrillation AFIRE Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease AMI Acute myocardial infarction ARB Angiotensin receptor blocker ARC-HBR Academic Research Consortium for High Bleeding Risk ARNI Angiotensin receptor/neprilysin inhibitor ASCVD Atherosclerotic cardiovascular disease ASSENT 3 ASsessment of the Safety and Efficacy of a New Thrombolytic 3 ATLANTIC Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST Elevation Myocardial Infarction to Open the Coronary Artery AUGUSTUS An Open-Label, 2 × 2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban Versus Vitamin K Antagonist and Aspirin Versus Aspirin Placebo in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention AV Atrioventricular BARC Bleeding Academic Research Consortium b.i.d. Bis in die (twice a day) BBB Bundle branch block BEACON Better Evaluation of Acute Chest Pain with Coronary Computed Tomography Angiography BETAMI BEtablocker Treatment After Acute Myocardial Infarction in Patients Without Reduced Left Ventricular Systolic Function BMS Bare metal stent BNP Brain natriuretic peptide CABG Coronary artery bypass grafting CAD Coronary artery disease CAPITAL-RCT Carvedilol Post-Intervention Long-Term Administration in Large-scale Randomized Controlled Trial CAPRICORN CArvedilol Post-infaRct survIval COntRolled evaluatioN CCS Chronic coronary syndrome Downloaded from academic.oup.com/eurheartj/article/44/38/3720/7243210 by guest on 07 October 2026