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presenting without persistent ST-segment elevation. EHJ 2011. Published September 21, 2011

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( )
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.


99%.
Moeckel M. Instant early rule-out using cardiac troponin and copeptin
in low- to intermediate-risk patients with suspected ACS:
A prospective, randomized multicenter study. ESC Congress 2013.


, ,

10 /

< 10 /

30 9 MACE
( )

n=902

BIC-8.

Moeckel M. Instant early rule-out using cardiac troponin and copeptin

in low- to intermediate-risk patients with suspected ACS:
A prospective, randomized multicenter study. ESC Congress 2013.

BIC-8.
MACE 30

(n=451) (n=451)
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%%

MACE

--
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Moeckel M. ESC Congress 2013.

BIC-8

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(2)

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ESC 2013

Kurt Huber, FESC, FACC, FAHA.

Disclosure -
, : Astra Zeneka .
,
: Astra Zeneka

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Huber K., ESC 2013

 () (2)
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 (AHA) (ESC)

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Differences in the interpretation of study results might be explained by the fact that European authors of NSTE-ACS and STEMI guidelines
analyse primarily the data of international trials and meta-analyses that have been published in (often high-rated) journals, while North American
experts occasionally also take additional information into account, which comes up, for example, during the approval process for new agents with
the Food and Drug Administration (FDA). While European experts avoid giving subgroup analyses of original papers too much attention, this
seems occasionally to happen with US guidelines.

Differences between ACC/AHA and ESC Guidelines on antiplatelet therapy in patients

with acute coronary syndromes. Huber K; Lip GYH. Thromb Haemost 2013; 110: 11

 ( - mismatch)

P2Y12

In contrast to the US recommendations, current ESC ACS Guidelines, with regard to their
recommendation of the novel oral antiplatelet agents (ticagrelor and prasugrel) over
clopidogrel are overoptimistic and not evidence-based

,
ESC
( )

.
Serebruany VL, DiNicolantonio JJ. Viewpoint: Mismatch between the European
and American guidelines on oral antiplatelet P2Y12 inhibitors after acute coronary syndromes.
Thromb Haemost 2013; 110: 5


ST K. Huber, ESC 2013

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PFT may be considered in selected cases when clopidogrel is
NSTE-ACS used. so far, the routine clinical use of PFT in clopidogrel2011
treated patients with ACS cannot be recommended.
PFT may be considered in patients at high risk for poor clinical
outcomes. In patients treated with clopidogrel with high platelet
ACC/
reactivity, alternative agents, such as prasugrel or ticagrelor,
AHA/SCAI
might be considered. The routine clinical use of platelet
PCI 2011
function testing to screen patients treated with clopidogrel
who are undergoing PCI is not recommended.
PFT to determine platelet inhibitory response in patients
ACCF/AHA
with UA/NSTEMI (or, after ACS and PCI) on P2Y12-receptor
UA/NSTEMI
inhibitor therapy may be considered if results of testing may
2012
alter management.
ESC STEMI
No specific recommendation.
2012
ACCF/AHA The roles of PFT and genetic screening for clopidogrel
STEMI2013 metabolism in the acute phase of STEMI care are uncertain.
COLLET JP. Platelet function testing should be abandoned? YES!

CoR LoE
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Montalescot G, et al for the ACCOAST Investigators. Pretreatment with Prasugrel

in NonST-Segment Elevation Acute Coronary Syndromes. N Engl J Med 2013;369:999.
Montalescot G, ESC Congress 2013

ACCOAST
( )

Montalescot G, et al for the ACCOAST Investigators. Pretreatment with Prasugrel in NonST-Segment Elevation Acute
Coronary Syndromes. N Engl J Med 2013;369:999.
Montalescot G, ESC Congress 2013

ACCOAST
()

Montalescot G, et al for the ACCOAST Investigators. Pretreatment with Prasugrel in NonST-Segment Elevation Acute
Coronary Syndromes. N Engl J Med 2013;369:999.
Montalescot G, ESC Congress 2013

ACCOAST TIMI
()

Montalescot G, et al for the ACCOAST Investigators. Pretreatment with Prasugrel in NonST-Segment Elevation Acute
Coronary Syndromes. N Engl J Med 2013;369:999.
Montalescot G, ESC Congress 2013

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Montalescot G, et al for the ACCOAST Investigators. Pretreatment with Prasugrel in NonST-Segment Elevation Acute
Coronary Syndromes. N Engl J Med 2013;369:999.
Montalescot G, ESC Congress 2013

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Mehran R. et al. Lancet. Published Online Sep. 1, 2013

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Mehran R. Congress ESC 2013

Mehran R. et al. Lancet. Published Online Sep. 1, 2013

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Mehran R. Congress ESC 2013

discontinuation

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Mehran R. et al. Lancet. Published Online Sep.1,2013

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N (%)
N (%)

(N)

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249 (1.9)

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545 (2.9)

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Krantz MJ, Kaul S. ATLAS ACS-TIMI 51 and Missing Data. JACC (2013)


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TAO : Treatment of Acute Coronary Syndromes with Otamixaban

Intrinsic pathway
FXII, FXI, FIX,
FVIII, PL, Ca2+

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Tissue factor, FVII

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Sabatine MS et al. Otamixaban for the treatment of patients with non-ST-elevation ACS
(SEPIA-ACS1 TIMI 42): a randomised, double-blind, active-controlled, phase 2 trial.
Lancet 2009; 374: 787.

 -, %

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2013, 1