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(Circulation. 2005;112:III-55 – III-72.)
© 2005 American Heart Association, Inc.

Section 1

Part 5: Acute Coronary Syndromes

From the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23–30, 2005.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The American Heart Association and the American College of Cardiology,^1,2 the European Society of Cardiology^3,4 and others⁵ have developed comprehensive guidelines for the in-hospital management of patients with ST-elevation myocardial infarction (STEMI)² and for unstable angina (UA) and non–ST-elevation MI (NSTEMI).¹ The International Liaison Committee on Resuscitation (ILCOR) Acute Coronary Syndromes (ACS)/Acute Myocardial Infarction (AMI) Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS/AMI in the out-of-hospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED).

Much of the research concerning the care of the patient with ACS has been conducted on in-hospital populations rather than in the ED or out-of-hospital settings. By definition, extending the conclusions from such research to the early ED management strategy or the out-of-hospital setting requires extrapolation classified as level of evidence 7.

	Diagnostic Tests in ACS and AMI

 
The sensitivity, specificity, and clinical impact of various diagnostic strategies in ACS/AMI have been evaluated. These include signs and symptoms, cardiac markers, and 12-lead electrocardiogram (ECG). The standard ILCOR/AHA levels of evidence (described in Part 1: "Introduction") pertain largely to therapeutic interventions. For this reason, in the evaluation of evidence for diagnostic accuracy the reviewers used the Centre for Evidence-Based Medicine (CEBM) levels of evidence for diagnostic tests (http://www.cebm.net/levels _of_evidence.asp). The CEBM levels are cited as "levels" and the ILCOR/AHA levels of evidence are designated with "LOE," for "level of evidence."

Neither signs and symptoms nor cardiac markers alone are sufficiently sensitive to diagnose AMI or ischemia in the prehospital . . . [Full Text of this Article]