2023 | Pocket Guidelines felt talte-1Bsr-laela Guidelines Committee ACUTE CORONARY SYNDROMES Guidelines for the management of acute coronary syndromes ESC European Society af Cardiology e 03 ‘ophia Antipolis Cedex France ESC European Society of Cardiology Phone: +3 Email: quidelines@escardia.org wwwescardio.org/quldelines Download the AppESC Classes of recommendations and levels of evidence “Table 1 Classes of recommendations Defaton Wording use ‘csi (Beane anaiorgneralagreerent ats {ven extent or proceauels bere, ‘Sell ect hss Coating evidence acioca ergece of pinion bout the ‘hafleclieny othe gen resrert or frocedure Cassin | Woigtofevisencaepnion si four ct oehonesteeacy Cheep | Usehnesefiaey is ess wel ‘sablahed by evdencfopin. cows [Bidanes oF average that he [ven ester or procedure sot veal ‘fects andi sre cee ay be ara “Table? Levels of evidence {Concorso eprion ofthe ers acral ste, Since Soest se ern ESC Pocket Guidelines 12023 ESC Guidelines on the management cof acute coronary syndromes" Dosen by et ree ente mage fears sromes ‘le Eiepean Suto cartcag ES) bers Byrne Bora bane Dept of Cdl) an Caorcae ‘intl ese Denen, east C48) Cerro Nico deiretpcones Nr rinse NemorksedCSIUshersty Carsales Cas feN) ad arsenate ces Grey Dsprast Is unc “aseForee Members: ave Reso Tas Force Cooter) (pi |} Conan Tk Fre Caordntor nd Ear Burtt (a) Cain Bey (Unites Kg, Ae Chet i Pre | Cae (tig), Ghesrate Ante Dan (Ronan, Pare R Duck (Uses Knginn) Mary Gabroh (Untes King Marte Glad (rae) Lene Herbier (Ast Ea Atta (lr, Pt Jn (Utes King, Teh Ka pr Vit Karaan (Und rycen), attest’ meer Robt Lora Netra Robra FE ee al, Agee {GRippouo (Gwe) Miva Rr Ginener (Germany ae Tse Caan Planck (Gen Ser asa (ery Rae ar Wenge Usted estes Are) Sees ot on 7Table of Contents Introdicton 1. Definitions ace coronary syndromes and moar inaction “rage and digress 21, Cline presentation an phys examination 22, Dingo tol | lectrocaogam 221, Aete coronary syiome wth persistent ST-segment devon 10 222, Rete coronary syndrome wateur perstent STesegrenteleaton (NSTE-ACS) 10 2, Diagost too | Bomarkes t 231 Hightenstity cada woponins 1 114, Disgrostic too | Nen ive nag a Ii messires fo pains preverting with suspected aie corerary syndrome nial veatment— 8 LL. Pre-hespal logis ofcare—__ 8 ‘Acute-shase management f patients wih aca coronary sero 8 41. Selection onasivesategy ae reperfusion therapy 8 42, cnojis and pharmaco-inasve strategy patients wth STEML __18 ‘Antthrembitherapy —_ 0 51. Antltlet therapy the acute phase n 5.2, rite therapy pints reqring ral aeaguon 53, Anttrombotic therapy 2s an art to rina ‘ate coronary synrome wth usable pesetaton 61, Cardogeie shock complatng act coronary yrome Managemen of sit coronary syndrome dureghosptalzaton Techie aspectsofirasve strategies. aragerent f patents with mutes! disease. 191, Management ofmulevesel date nace coronary syrrome completes by cardiogenic shoe & weeeeee 10. Myocardial infrction with ron-obstuctve coronary artes 11, Spoci stustions E ‘14. Type 2 Myocardalinarction andacte ayer 112. Compleatons 113, Comerbid condtions 12 Lengteer treatment 18, Paton perspcthes. 2 131 Paventconrec care SB Patentstsacton and expectation: 183 Preparation for dicharge 1. Sex erences — 28 4 4 a 45 at st st s4 384. Introduction ‘The European Society of Carcilogy (SC) as recerly completed compeehersve view ofthe exiting state of medica evidence relatngto acute coronary syndromes {ACS} Chases ef recommencstion ard lees of evidence have been evaluated anc tzored according tothe definton shown n Table 1 and Table 2 ‘Ths quick reference booklet sunmarzes clin care nfermaton extracted from the fl gidelnes Foe greater deals. pease refer to the published ful guideline salable twrwescardocorggulines. “The major aspects ofthe management of patients with ACS are summarized in Figwe 1.4. Definitions acute coronary syndromes and myocardial infarction ‘ate coronary syeromes (ACS) encompass a spectrum of corto thatincude patents presenang wth recent changes in cnc symptoms or sigs, with oF twthout changes on Tend elctrcardiogram (ECG) and wit or without acute ‘eetons in erdac troponin (Tr) concentrations (gure 2), Patents presenting ‘uth suspected ACS may eventual receve a dagnosso cite myocar infarction {tor unstable angina (UA), The dagnoss of Mls associated with eT release and is made based onthe fourth universal definition of Ml, Us defined as myocardial iseaemia at rest or on minimal exertion inthe absence of acute cardiomyocyte inuryecrois Figure 1 Central ilstration. [ACS encompasses a spectrum “Tank evmercton "ee e@°o @esc 3. ony tn CABG yp pg drag ee einen te cen pene) eeFigure 2 The spectrum of clinical presentations electrocardiographic ‘ndings, and bigh-renstvtycardac troponin lvalsin pation with acute coronary syndrome. ® WESC. SSistdceratce ene aire NEN Scent on EM, Ta bwesresieae Patios presenting vith supocted ACS are typealy casted tased on ECG at presentation forthe purpose af intl maagemer. ter this, patents an be‘urther| assed base onthe presence or absence ofc eleation nce these resis are valle) ae demonsatedin Figure 2 and Figure 3. z Figure 3 Classification of pationts presenting with suspected acute coronary syndrome: roma working a 3final diagnosis. esc Sarre ree cmeerere remem Sopa sre ener Se eeeitotmet eieicteteesamter eters Snoesareae pence eee, Sor 2. Triage and diagnosis 2.4. Clinical presentation and physical examination ‘Acute chest d5comfert isthe leaigpreserigsymptom prompting consideration of the nal dagoss of ACS are the nation of esting aged wth specie dagnostic algcthns (ure 4). (Chest paineqaalent symptoms indude dyspea, pga: pain pain inthe et rae arm or neck.re4 An overview ofthe ial lage, management and inesigation ‘Stputens whe present wth spe an symptons potently consent ‘nh scite coronary syndrome. @0° 666606 sccm ran arm Aare re CARE ay ey ps erate Scot necesntten stueus meoraeacce “Neasatecnmmronet reese rite aio ACS et ec a pte wth conkoy pests a hgh ACS) naar es Titan torpowee anne ACh ts tater oma Foren th TEAS wings tse orem nour ke ocedbccraarend ‘ade mane neers sree romps assesment of vitals is recemmended a frst medical contact (FMC), at ‘the sume time as 2eqution ofan til ECG (Figure 5). Figure § The A.CSS. assessment fr the intial evaluation of patient with suspected acute coronary syndrome. ‘tps 6 ececrtagon 2.2 Diagnostic tools | Electrocardiogram ‘The resting Tlead ECG isthe fstlinedagneatic toon the assessment of pats vith suspected ACS. ts recommended that an ECG i obtained immediatly upon YC and nterpreted by aqui emergency medal technician o: physician within ‘min. Based on the intial ECG, paints with suspected ACS canbe diferentated into two working diagnose: "+ Paint wth acute chest pain fr chest pan-equalentsignsyptoms) and Dersitent ST-segment elation (or ST-segnnt elevation equvalrs) on ECG (working dagnoss: ST-segment elevaon ML: STEM). + Pavens with acute cst pain (or chest pain-equvalentsgnoymptoms) but without penitent ST-segment eatin (or ST-egnent’ cevation equialens) on EC (working diagnosis nen-ST-eevation (NSTE}ACS).2.24, Acute coronary syndrome with persistent ST-segment elevation ‘New ST elevation athe pon in at ast two contiguous leads fmeasred atthe [}por) considered sugestive of ongoing coronary artery act occlusion inthe appropriate clinical context. ‘The prot for these patents isthe implementation reperfusion therapy 8 soon as possible ee Sein 4) in patents wih suspected inferior STEMI, itis recommended to record right precordal leads (V3R and VAR), whch may hlp to Identify conconntae rh ‘eticlrinfrcton, Posteri eas (V7-V9) can also be recorded to investigate for posterior STEMI parteuary in patlerts with engoing symptoms and an inconclusive standard Dead ECG. ‘The dagnsis of ongoing site coronary artry occlusion on ECG ean sometimes be chalengng, ard some eiges may warrant prompt management and tage for imedate reperfusion therapy derpte the absence of ST-segment lention, 1122. Acute coronary syndrome without persstnt ST-segment elevation (NSTE-ACS) ‘While the ECG in the setng of NSTE-ACS may be norma, characteristic ECG sbnormaties are fequerly present and merase the dgnoste probably of ACS. “These ECG abnormaitis ince ST depression, T wave changes (especialy biphasic T waves or prominent neve T waves), andlr U wave inversion Recommendation for cinial and dlagnostic tools for patients with suspected acute coronary syndrome ce Chass Level iisreommende eb the diagnosis inal sorter sk Srateatono ACS ons comin of ral Ror, spon, vial og ote phys fags, ECG doch cs “whe lea EG recording rare recommend 3 cn spore tte parte FN, wea te of <10 mi, CCominuus EC montern andthe bit felon Capac reconvened as s0on 3 posible al Fr wth Sispected STEM, naapctes ACS wih ter ECG cages ruin cest pn ad ore the gro of Ms rude w ‘Recommendations for cial and dlagnotic tool for palents with ‘suspected acute coronary syndrome continued). ECG (continued) The we of nronl ECG ka VOR VAR ae V7-V9) 5 recomended iene of fri STEMI eft wl chon Ss suspected ane stndudleade sence, An toa 12d ECG i recommended cases with eure symp er digrstcuncetiy : Blood sampling ttsrecomeronced to messed Yop wth hi 2erstivy aus inmedaty ate presertaton toca the rests wien 60min of ond sanping Ienrecrmended to usean ESC are proach ith eri heTo mesures (011 ber OEM) to rae inant al oe NsTeMt Adora testing afer 3h recomend the frst wo fs a renuremertsf the ONT h lore are nerds ano ‘erate daposes exp the condo hare een made, “The te of established rk cere (eg GRACE rks for Progoss estimation shoul be ered ‘Tage for emergency reperfusion strategy Ieeracommerded tha paves with aupected STEM are ienedateytragd fort energy reperison sty. feiss ge sett tr 2.3, Diagnostic tools Biomarkers 2.31 Highseasewty card trponns ‘ter excirg cna snd EG seg of STEM or ery hk NSE: ACS, lores phy conplerunry re the depen, sation ane magento ales wah anges ACS. Mesremet of ere of carat ir. rls Nesey eardac Wop tec) recormended na patents wth spced ACS. te dna presence ee esoe ador fan cla sho the 3th conpate wih marl ache hea ead sera of ey nan pos oa agosto HL recmerded eethcd Mt haart es option) oth NZ agri Geet pn) pte 1d rule-in algorithms using Fire 6h Ot nar Oh rue-out an rein rcs ig saponin sayin patents peseting ema dearement vith urpeted STEMI and without an aan ‘Sriumedate mate ngoqy- @Esc- ee neue Selpuinersaocsteoccungeepilies ibis re onssanone oer parse Oh heer a 24, Diagnostic tools | Non-invasive imaging Recommendations for non-invasive imagng patents with ACS are summarized below ‘Recommendation for non-invasive imaging ln te inal assessment of patients with suspected acute coronary syndrome Recommendations Emergency TTEisrcommende in parts wth aspect ACS preserig wth ardogen sod or pected medal ‘completions Inpatients wth spect ACS, noo-latedornceri) Ta level 0 ECG canes an reaarece of pn neorporang, CCTAor a nowimatie sess rag tea fart the al wou shad be cosiere. Class Level By 2 ¢ Accu cry yt: CTA cen erp aeangr ay KE ceroceg "ech inuy coastga TE toto wecntepg Emapcy TEshoud be considered twinge incase of grote certainty bt ths should a reat cy raster the care athteretion boron teres upon cf nace corony tery acon. Routine, xy CCTAn piers wth spect CS isnt recommended 3. Initial measures for patients presenting with suspected ‘acute coronary syndrome | initial treatment 3.1, Pre-hospitallogsties of eare Inviuls expereneng acite chest pat inthe consruity shoudl undergo immedi ak assessment and eg lowing lc! protecls eabished thn the eme-gncy medial serve. A Tend ECG sould be acqured ard anajsed a soon as posble Patents wth suspected ACS are nly categorized onthe bas ofthe Den ECG ad riage imo tw tl exert paths () ner patents wth an ECG constr wth STEMI (pesntert ST-segment elation or equates ECG patterns (Figure 7) and (an er patents without Sserent evan or equivalent ECG pater (supeced NSTE-ACS) (gue) aRecommendations forthe initial management of patients with acute coronary syndrome Recommendations clas Level Hypoxia Oop ireonmentedin peas wth panera (0:50) mag vim c Asin ongenle not recommended in sir wtheut rypansena (20908). Symptoms Irrerous opis shoe conacered tral pan ‘A midrange ho corer var nsious pats Ineravenous beta-blockers lnrweros tea ocr preferably metoproa) sosd be “ced at the tel peeration npn erg PPC Sith osgect ste hear ure anSEP TED gn 10 ‘her eonandieson. Pre-hospial ogists of ere ts recommend ta the pre-hospital ranaperent of patents ith woring Sago f STEMS bass on rene meters ‘sgpdto deer repertson therapy expt rd etry, wih efforts me to mae PPCI abe my sents spore Its econmmendd tha PFC cpibl centres deter 247 sre io {hd arbi peor PC thet. Ineracommerdes fut patents waned for PPC bps he tier department and CCUNCU are raed ety {Site theta bors arcemedtia rae ersten Te UM toa Clapble cere, ypteng non Pleats Iesrecommended that antics ers are trained and epupoed to der Et pats suggest coroar ction and testinal heap, lug rion, aa when peat c ‘Recommendations fr the intial management of patients with acute ‘coronary syndrome (continued) Recommendations Pre-hosptal logistes of care (continued) recommended hata hosp and EMS partir nthe are of patents wth pected STEM receded ude Sy cs c and rktogeirtachee acre qty args lass Level 4, Acute-phase management of patients with acute coronary syndrome 44, Selection of invasive strategy and reperfusion therapy Theva seeps tr pct ah AS re nr se 1 and the recommendation table. ah iied ¥Figure 7 Modes of presentation and pathways to invasive management and Figur Selina iratepy nd reperfusion thorapy in pains Inyocardal revacularzation inpatient presenting with STEMI, oa, BBS42. Fbrnolysis and pharmaco-ivasve strategy in patients with STEM! Final therapy 130 important repertson Srategy for STEMI patents presenting within 12 h of symptom onset when primary peeutareous orerary ‘enenton cnrotbe performed i 3 tinay mance Success epertuson eeraly associated with sgniiant inprorevent in ichaenic Symptons, 230% STegment resolution and heemodyrami tabi, Recommendation for reperfusion thrapy and timing ofimvave strategy Recommendations Class Level Recommendation for reperfusion therapy for patents with STEML Fepechton they i recormandedin lpr wth working ‘gros of STEM (ersten Teper Sleaton or eat) Sab ynptonsetschieria of 12h rton ‘AP? rateyiereormendes oer rio heated time from dagrossto PCs 20 it, funey PCI 120m) camer be pererned inpatients wth werk goss of STEN, Psyc thay seamed ri I yptom azetin pater thot contrandatns ese Pi recommended rn (ie STsepmert reroten 3 rent nd ale 6 we ‘er who are expecta to sire fates yea wih ood function See remaster soa aaa Carel Teac “Transventus catheter pacing termination and/or overdrive pacing, ~ oud be sve 'VT canoe controle y rene eave ardonrsor. falequnc catheter sign ata pecilaed latin centre {iow by 10D atti so be coded nets a vwithrcurere VI or elec torm dpe comple easelaezion ad opti medal thera. “reatret of recent VT wthhsemodac ean site repented each carsonerso) with aca nay De conseree eS feet boctes, amiodarone, ad oreciesraion erat ‘Aecegpcable, Inpteres wth cure etree verre arytnmas station or ees aethesa toredue symp ve maybe cc ene ICD mprtaton re tenparayuse ofa wear crdonrer tefl yb coded 40 dp ser Min ets ptets cane rection re-onting LVEF asuncn ccarer (sarap Bh ser STEM ona perp VT oF) Trimet smptomstc and berate {entry with aye Sos ‘acer a"Recommendations for acute coronary syndrome complications (ontinued) Recommendstons Gai tisei Bradyarrhyehine hao rasta when rc ei eps AV “without stable escape rhythrr: ae In poste vantage medstion fea. eopresh, _ancler atrepine) is recommended, ie ee = | Ses : en dase lnplrision cs parmanent paces rormerd when hig-degree AV bec oe ro revo witina wating period ot © Insslocted patents wh ghee AV oc he coment an Anta allan act HE ety device pion ERT-D! fc (CREP) maybe cones Pung int recrmened hh degree A blokes ter rensesaaten or porns, ames ee eecnslaeenereececeteee Soonce eee Doeuienoeiegameeges corms Sa a 11.3. Comorbid conditions ‘Recommendations for acute corenary symdrome comorbid conditions Recommendations cass Level Chronic kidney dsase “These of ov: ko-omnabc ontrst med tthe lowest G- c onl vlan) recommended or mati eps tb reconmanded toss le fonction usr GFR inal Peters ACS, lisrecrmended to apy the sme dread thrapeuic Seep pert wth CKD ose sdstrent may be essay) en pert th crm ney forte, “Heaton eng and ser gop shoul be conser Le al cece dea crept wren pater wth act ny nuryanler CKD wth GFR ‘0 mT Diabetes ‘esrecommendedt be the choi oflngerm gas Joma ‘tester ante presnce of cvorbdes neigh, (CKD an tasty. Ins recormendedto snes gear ats tint enliton pees ith ACS. Iisreommended to requ mente ood costes in Faber wih ino daetes melas or hperyeaema (fe x a Pypoaeaema stele aad. cnnaeas : sas ‘Guess onan therapy shel be onder i patents ‘wth ACS weh persia hperaynema, whe ode of leis recommende to appiythe same dagnostic and wrestment mi ‘atapes mor pers nyourge patents BRecommendations fr acute coronary syndrome comorbid candtons| {continued} Recommendations Class Level (der adults (continued) kis recormende oa the cbce and dog. eithrombot ih wel rT cay eon Iedcitors, to renal lncton comedetions como, Fay, ‘opine rein and spect corandetons Fer oper ith comartites el proche ‘onda neva sarage treatment after cart evalation of th risk and Beefs as eS Sagal = aaa ea ean Se a Soa en eon ness areas ‘A conser noninase trate shoul be considered in ACS tents wih por cater propos ia with expected urn © ‘bmorehs) andrvery ihe rsh, o Ipasreerars i ene Sah nee [wy c ° on ~~ ° Ain ao SOc rasugrel or eagrlor ave not reco +2 % 12. Long-term treatment Secondary prevention after ACS is important to increase qualty of ie and to ‘decreae morbidity and mertalty Thisshouldstartas early asposbeafter the index ‘vent Optimal mada therapy and treatment targets re sutrevared in igure 16 |AI|ACS patents shuld parecoste in comprenensve cardiac retabitaton (CR) programe, which should start a8 ey as possbe after the ACS event. The fore components of CR nce patent assessment, maragement and convol of Cardioaseuar rik faetors,physal acy counseling prescription of exercise traning, etary adie, tobacco. counselig, patent education, psychosocial rmanagemert, and vestionl support Details of recommendations forthe lng term management of pairs post ACS i proved inthe recommenction table below. a‘An algorithm for lipttlowering management in ACS patents outned in Figure 16 Long-term management after acute coronary syndrome.Recommendations for long-term management Recommendations ‘cass Level ‘carciacrohabilestion llsrecommended ht ACS piers parte na medaly supariied sracuredconpetenive, miliary ere bused casa refabitton ad prevetion prgrorme Liteseyle management Inierecommendedtha AS patents dogs eats, incuare opie al moe obaco eth det dtersean ye) alae repr aero psc att nd eines ever redid sederary tine In snolers ofr flinrap apport. te rephcenert ‘harap. arene c proper, edaly or combnaton Soul te conser Pharmacological treatment pid dowerig rey Iisrecarmended ht high-dose sti therapy iad or continued sey posite, reardessf rial LLC aes Iisreonmanded wo ant see a9 LOL lel <4 mr [cSS gl) ae toredce LDL by 2508 fe asin the LDLC gous not cher este mxinaly tert stat therapy ater 4-6 wens te aon of eee recormended he LDL-C ga isntachved deste rosin tlt in ‘heap ard excmbe ater 4-6 weds the ston PESES lor recone Ilsrecommandel ote Ip lowang therapy dng the née ACS spelen for pret who wer on Id lonerng era aelore sion w Recommendations or long-term management (continued) Recommendations lass Level ‘Pharmacologel treatment (continued) powering therapy cried) Fer pres wth arecettherotvomtti eet recience within 2 ers frst ACS epzode) wl aking max tlertd Stent therapy. an LDL-C ga of 1.0 mma 40 mele) ry be conic CCembinston therapy ith hih ote stat ls exam consered dug ospaaton eco becker eeSloctes re recommenddin ACS ptt wth LYE 40% ee i Inte AAS pep NE hd SS AAS ster inhors Angjtennconvringenaye (ACE) initio? ae econmendat In ACS patents with Espns, WEF <4, betes, Iypertenson ardor CxO. Merlcoiedrecptranagoris are recommended i ACS pater wth n LVEF 0% an H dts, Rowire ACE itor fo af ACS pater eps of LVEF shoud be conadered [Adberence to medication ' pall shouldbe conser an option te nproveahorarce ss otearer secondary preeonater ACS. Imaging In pts thre daharge LVEF 40% reps eaution ft LVEF 6-2 weak eran ACS rd er compite rescrtn ané entation of ptinal ede tera) i cc rcormendes oases th pot eed or sun er ath fran preveionCD mparaion aRecommendations for long-term management (continued) Recommendations Class Level imaging (Continued) ‘Carne magnetic resonance shouldbe considered a anadurtive imap madly neato set the potential redo prmary © prevestoniCD mpaion Vaccination Inuonzsacntionreconenended er ACS pte ‘Anti-inflammatory drugs Lowedoe coke (05 mg ance diya be consis, partedary Wether rks ar scent conrad or Frecurenterdgasalt ese arts err under ope FA sea. H ‘naa a joe te paolo enon ine ee {sven t peers eFC ont te pep “Sree merase cn vce 13, Patient perspectives 131. Patient-centred care ‘The management of patients with ACS should be mindful ofthe provision of care that is respectful of and resprsie to hndvidal pation preferences, needs and vals, ensuing that thee vale ae eluded i cial dct naking Engaging and educating the paints key component of ACS ear an shuld take place throughout their patent journey, Fom admission to hoeptal dacharge and ER (igure 18, = Figure 18 person-centred approach tothe ACS journey. “Takings person-contred approach tothe ACS Journey rsa contr pt payee ess ©oe 90 © 0 © @ woo tee “Gusmmer Siiceae eee 9 esc. cS sateen aan a13.2, Pationt satisfaction and expectations Patient perception of cari but on inte-personalinteractions te qualty of cncal communication, dlvery of care, andthe adminstative management of care. ACS patient expectatons are summarzed in Figure 1. Figure 19 Acuto coronary syndrome patient expectations. ACS patients expect. ‘reson _ v =o a v AS te capone 13,3. Preparation for discharge Many ACS patents may rot be fly aware of what has happened to them and how to best manage their heatcare after cscharge, lig to them both wanting and needing more nformston upon dichage, Discharge information shoud be provided both verbal an writen formats and shoul nce 2 charge letter ‘unin he key components ofthe evidence-based dscharge pn, ‘Recommendations fr pationt perspectives in acute coronary syndrome ‘Recommendations Patent cere ares reconendedby snesing nd ache ‘to nv ptet pelorerces ees ad bel, esr tat Dates re edo nor cnc econ es ees Sa ae | (CissLevel faders eats. raaton exponen tera opto Deion as cn bua oat te cen eis recommeded to aes symptoms ing etd hatha patent to dearbe thee experave, Usefthe ‘ech ba taciqe fr econ support daring the seeanng of nfored conse shoud be conor Patent dic information shout proved both writen ad veo omits pro daca Aegit reparton ane ‘etn for gate dsctage sh the tech bak ecg ar) or metvatralnevewrg eng ormaten in chunks and Chechig or understanding Se be considered Assent of rental wall bhg sing a aldstedtol ad onward iol when propriate shoud conse, a s14, Sex differences Several studies have reported that women presenting wih ACS are tested Ciferently than men. Ths includes being less lly than men to receve ICA, timely revascarization, CR, and secondary prevenon mediation, Heatheare providers and pley makers shouldbe conscious ofthis potential ender bas nthe ‘management of ACS, and make concerted eflartt ensure tht women wit ACS, receive evidence-based care @eEsc European Society ‘of Cardiology {© 2023 The European Society of Cardiology. All rights reserved, “Tee mate as aps on he 2623 5C Guido nu mage of sen ora eadrome (Guopen Hear ours 200) oo 08Seareat ful) pind on 25 Aug 2023, "Sone bred on ancrectedprocfereaed on 1) 2021 ost paaten covert sd apts are ae ceewncrdacypseet cenyrite. Se tite ose Euan Sty of Coote (SC) Foat Gales at bon pbb Jroorlané eatin lr ny Ne conmecal wei shores ND pat fe ES Pt Gens ‘Deamon a tar wren permaon fe be inion te cite oon nbmison ea writen reer t ES, Cine Pace Gudees Depron ts Tenplr sRase es Cole -CS 079 bet OCD Soph Apt Ceder Frome En pines ar Te BC Goes orotate views of he ESC an were produces er cel consideration escent neal rege snd the evenee wale the eof Hee publeston The Es wnt rapansb nth et fy conrad aera) sn anbaty been {ES casa ny cher el entender dee est he reer pule [sh satortis prt elton gon of heaters or therapies ates Hoa Froestona ar crcturged oats e SC Gade il eo scaut hen everearg er ene gee al arn i saterinston diborane saga hese ‘oda stapes tower he ESC Glsnes noe over, ary way waco re ne "Sty of a elo ral een oars "conn or esa the pent erg Nov do the ESC Gunes exevp hay prssonal ron ‘ng Wt Lm xe conrton th roma eel uate recommen of gels ‘dy the comptes pe hathaorte eae forage och pate cs nite (Sita cepted dit rant hoe reece eho rots obgaons es s3 ‘eeth fraternal vespnay overly the spec re wd epson ean gp Sina deer th tine prion td take sire wither saree rson NS www.escardio.org/guidelines