❤️ Acute Coronary Syndrome: Reperfusion & Antithrombotics
UseUse to choose reperfusion in STEMI (primary PCI vs thrombolysis by time and feasibility) and intervention tim…
SourceByrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 20…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with emergency chest pain when deciding observation, rule-out, or ACS.
- Who it is not for
- Chest pain already clearly non-cardiac. No new ECG score.
- Formula and variables
- HEART is history, ECG, age, risk factors, and troponin. GRACE is age, heart rate, systolic pressure, creatinine, Killip, arrest, ST shift, and marker; the variant stays as on this page. TIMI and TIMI STEMI both exist; this page does not pick a new variant. Killip is pump class. No new chest-pain score.
- Result → next step
- Low risk stays with this page’s rule-out or observation. Once ACS is established, the next page is reperfusion and antithrombotic care. Bleeding uses CRUSADE. Stent duration uses the DAPT page. No loading dose is written.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.CRUSADE bleeding →DAPT duration →
- Guideline
- 2023 ESC ACS
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
NSTE-ACS is never thrombolysed; the decision is intervention timing by risk, whereas STEMI hinges on the earliest reperfusion. (original synthesis · not guideline verbatim)
When to use
Use to choose reperfusion in STEMI (primary PCI vs thrombolysis by time and feasibility) and intervention timing in NSTE-ACS by risk, with the antithrombotic backbone.
How it works
STEMI: primary PCI if feasible ≤ 120 min, else thrombolysis within 12 h then transfer. NSTE-ACS: no thrombolysis, intervention by risk (very-high, high, intermediate, low selective). DAPT (aspirin + ticagrelor) + parenteral anticoagulant.
Key points
- NSTE-ACS is never thrombolysed; the decision is intervention timing by risk, whereas STEMI hinges on the earliest reperfusion. (original synthesis · not guideline verbatim)
- Ticagrelor is the preferred P2Y12 agent; prasugrel is limited to known coronary anatomy planned for PCI.
- Add β-blocker, statin, and ACEi/ARB unless contraindicated, and assess bleeding risk (CRUSADE).
References
- [Guideline / primary source]Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| ACS type | STEMI (ST-elevation) |
|---|---|
| Primary PCI feasible within 120 min (for STEMI) | Yes |
| Time from onset (for STEMI) | 12–24 h |
| NSTE-ACS risk stratification | High risk |
→StrategySTEMI: reperfuse as early as possible
- Reperfusion：Primary PCI (preferred; FMC-to-wire-crossing ≤ where possible)
- Antiplatelet：Aspirin loading + P2Y12 (ticagrelor preferred, or clopidogrel), DAPT (duration per current guideline)
- Anticoagulation：Parenteral anticoagulation: unfractionated heparin or bivalirudin for primary PCI (bivalirudin favored with high bleeding risk); enoxaparin/UFH for thrombolysis
| ACS type | NSTE-ACS (NSTEMI/unstable angina) |
|---|---|
| Primary PCI feasible within 120 min (for STEMI) | No |
| Time from onset (for STEMI) | > 24 h |
| NSTE-ACS risk stratification | Low risk |
→StrategyNSTE-ACS: risk stratification defines intervention
- Intervention timing：No thrombolysis; by risk stratification: Selective intervention or non-invasive evaluation first
- Antiplatelet：Aspirin loading + P2Y12 (ticagrelor preferred; prasugrel limited to known coronary anatomy planned for PCI), DAPT (duration per current guideline)
- Anticoagulation：Parenteral anticoagulation: fondaparinux preferred for conservative treatment; UFH or enoxaparin for planned intervention
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Acute Coronary Syndrome: Reperfusion & Antithrombotics?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Acute Coronary Syndrome: Reperfusion & Antithrombotics upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Acute Coronary Syndrome: Reperfusion & Antithrombotics calculated in practice? Can you show a worked example?
- Inputs: ACS type STEMI (ST-elevation), Primary PCI feasible within 120 min (for STEMI) Yes, Time from onset (for STEMI) 12–24 h, NSTE-ACS risk stratification High risk → Result: Strategy STEMI: reperfuse as early as possible（Reperfusion: Primary PCI (preferred; FMC-to-wire-crossing ≤ where possible), Antiplatelet: Aspirin loading + P2Y12 (ticagrelor preferred, or clopidogrel), DAPT (duration per current guideline), Anticoagulation: Parenteral anticoagulation: unfractionated heparin or bivalirudin for primary PCI (bivalirudin favored with high bleeding risk); enoxaparin/UFH for thrombolysis） Inputs: ACS type NSTE-ACS (NSTEMI/unstable angina), Primary PCI feasible within 120 min (for STEMI) No, Time from onset (for STEMI) > 24 h, NSTE-ACS risk stratification Low risk → Result: Strategy NSTE-ACS: risk stratification defines intervention（Intervention timing: No thrombolysis; by risk stratification: Selective intervention or non-invasive evaluation first, Antiplatelet: Aspirin loading + P2Y12 (ticagrelor preferred; prasugrel limited to known coronary anatomy planned for PCI), DAPT (duration per current guideline), Anticoagulation: Parenteral anticoagulation: fondaparinux preferred for conservative treatment; UFH or enoxaparin for planned intervention）