Part 5: Acute Coronary Syndromes

The American Heart Association and the American College of Cardiology,1,2 the European Society of Cardiology3,4 and others5 have developed comprehensive guidelines for the in-hospital management of patients with ST-elevation myocardial infarction (STEMI)2 and for unstable angina (UA) and non–ST-elevation MI (NSTEMI).1 The International Liaison Committee on Resuscitation (ILCOR) Acute Coronary Syndromes (ACS)/Acute Myocardial Infarction (AMI) Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS/AMI in the out-of-hospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). Much of the research concerning the care of the patient with ACS has been conducted on in-hospital populations rather than in the ED or out-of-hospital settings. By definition, extending the conclusions from such research to the early ED management strategy or the out-of-hospital setting requires extrapolation classified as level of evidence 7.