What are the ILCOR guidelines on diagnostic intervention in acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

The 2015 revised international consensus guidelines on cardiopulmonary resuscitation and emergency cardiovascular care issued by the International Liaison Committee on Resuscitation (ILCOR). [113]

Evaluation

The 2015 ILCOR recommendations for diagnostic interventions in ACS include the following:

  • Prehospital 12-lead electrocardiographic (ECG) acquisition with hospital notification should be obtained for adult patients with suspected STEMI (strong recommendation, low-quality evidence).
  • Computer-assisted ECG interpretation can be used as an adjunct to identify STEMI (weak recommendation, very-low-quality evidence), but it should not be used alone to rule out STEMI because of the poor sensitivity of the computer algorithms evaluated (weak recommendation, very-low-quality evidence).
  • For patients with suspected STEMI outside of a hospital setting, nonphysicians may perform ECG interpretation to recognize STEMI in a system where the false-positive (FP) and false-negative (FN) rates are low (weak recommendation, very-low-quality evidence).
  • When primary percutaneous coronary intervention (PPCI) is the planned strategy, prehospital activation of the catheterization laboratory for PPCI is preferred (strong recommendation, very-low-quality evidence).
  • The use of troponins at 0 and 2 hours as a stand-alone measure for excluding the diagnosis of ACS is strongly discouraged (strong recommendation, very-low-quality evidence). Excluding the diagnosis of ACS can be accomplished by combining negative high-sensitivity cardiac troponin (hs-cTnI) measured at 0 and 2 hours with low-risk stratification or by combining negative cardiac troponin I (cTnI) or cardiac troponin T (cTnT) measured at 0 and 3 to 6 hours with very low risk stratification (weak recommendation, low-quality evidence).

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