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Acute coronary syndrome without ST elevation

Acute coronary syndrome without ST elevation. ASA - Nitrate - Beta-blocker – P2Y 12 inhibitor # - Anticoagulation *. HIGH RISK Recurrent severe ischemia Elevated troponin

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Acute coronary syndrome without ST elevation

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  1. Acute coronary syndrome without ST elevation ASA - Nitrate - Beta-blocker– P2Y12inhibitor # - Anticoagulation* HIGH RISK Recurrent severe ischemia Elevated troponin Hemodynamic instability Early post infarct angina Major arrhythmias (VF, VT) Diabetes mellitus # LOW RISK No recurrentischemia No troponinrise No diabetes Coronarography Urgent (< 2h) Early (< 72h) (< 24h if Grace > 140) Non-invasive testing Consider IIB-IIIA antagonist + heparin ORbivalirudin *Anticoagulation:Fondaparinux (+UHF in case of PCI) / Enoxaparin / UFH # P2Y12inhibitor: Ticagrelor /Prasugrel(reimbursement only in diabetic patients with PCI ) clopidogrel (high bleeding risk or low risk ACS)

  2. ST elevation MI (<12 h after onset of pain) ASA- Morphine - Heparin* - P2Y12inhibitor* Admission in PCI-center Admission in non-PCI-center OR 1st medical contact outside hospital • Transfer time to PCI center < 90 min • (transfer time<60 if ischemic time<2h) • Hemodynamic instability • (shock / cardiac failure/ malignant arrhythmias) • Contra-indication thrombolysis YES NO • Primary PCI • Thrombusaspiration • Bivalirudin • ( IIB-IIIaantagonistsforbail-out) Thrombolysis Failed Succes Rescue PCI Coronaro/ PCI 3-24h * • PPCI: UFH and Prasugrel 60 mg/ Ticagrelor 180mg • Trombolysis: Enoxaparin and clopidogrel 300mg (adjusteddoseif >75y)

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