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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Research grant (to the institution, UCR)
AstraZeneca, Daiichi Sankyo, Eli Lilly, BMS, Medtronic, Boston Scientific, Terumo
Inc, Vascular Solutions
Speaking or consulting:
AstraZeneca, Eli Lilly, Merck, Sanofi-Aventis, Boston Scientific
Stockholding: None
Stefan James Potential conflicts of interest
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Gabriel Steg Potential conflicts of interest
Research grant (to the institution: INSERM U698):
NYU School of Medicine, Sanofi, Servier
Speaking or consulting:
Ablynx, Amarin, Astellas, AstraZeneca, Bayer, Boehringer- Ingelheim, BMS, Daiichi-
Sankyo-Lilly, GSK, Medtronic, Merck, Novartis, Otsuka, Pfizer, Roche, sanofi,
Servier, The Medicines Company
Stockholding: Aterovax
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
European Heart Journal
doi:10.1093/eurheartj/ehs215
ESC Guidelines for the management of acute myocardial
infarction in patients presenting with ST-segment
elevation The Task Force on the management of ST-segment elevation acute myocardial
infarction of the European Society of Cardiology
Authors/Task Force Members: Ph. Gabriel Steg (Chairperson) (France)*, Stefan K. James (Chairperson) (Sweden)*, Dan Atar
(Norway), Luigi P. Badano (Italy), Carina Blomstrom Lundqvist (Sweden), Michael A. Borger (Germany), Carlo Di Mario (United
Kingdom), Kenneth Dickstein (Norway), Gregory Ducrocq (France), Francisco Fernandez-Aviles (Spain), Anthony H. Gershlick (United
Kingdom), Pantaleo Giannuzzi (Italy), Sigrun Halvorsen (Norway), Kurt Huber (Austria), Peter Juni (Switzerland), Adnan Kastrati
(Germany), Juhani Knuuti (Finland), Mattie J. Lenzen (Netherlands), Kenneth W. Mahaffey (USA), Marco Valgimigli (Italy), Arnoud van't
Hof (Netherlands), Petr Widimsky (Czech Republic), Doron Zahger (Israel)
ESC Committee for Practice Guidelines (CPG): Jeroen J. Bax (Chairman) (Netherlands), Helmut Baumgartner (Germany), Claudio
Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard (Belgium), Christian Funck-Brentano (France), David Hasdai
(Israel), Arno Hoes (Netherlands), Paulus Kirchhof (Germany/UK), Juhani Knuuti (Finland), Philippe Kolh (Belgium), Theresa McDonagh
(UK), Cyril Moulin (France), Bogdan A. Popescu (Romania), Željko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes
(Norway), Michal Tendera (Poland), Adam Torbicki (Poland), Alec Vahanian (France), Stephan Windecker (Switzerland)
Document Reviewers: David Hasdai (CPG Review Coordinator) (Israel), Felicity Astin (UK), Karin Åström-Olsson (Sweden), Andrzej
Budaj (Poland), Peter Clemmensen (Denmark), Jean-Philippe Collet (France), Keith A. Fox (UK), Ahmet Fuat (UK), Olivija Gustiene
(Lithuania), Christian W. Hamm (Germany), Petr Kala (Czech Replublic), Patrizio Lancellotti (Belgium), Aldo Pietro Maggioni (Italy), Béla
Merkely (Hungary), Franz-Josef Neumann (Germany), Massimo F. Piepoli (Italy), Frans Van de Werf (Belgium), Freek Verheugt
(Netherlands), Lars Wallentin (Sweden)
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Classes of recommendations
Classes of recommendations
Definition Suggested wording to use
Class I Evidence and/or general agreement
that a given treatment or procedure is
beneficial, useful, effective.
Is recommmended/
is indicated.
Class II Conflicting evidence and/or a
divergence of opinion about the
usefulness/efficacy of the given
treatment or procedure.
Class IIa Weight of evidence/opinion is in
favour of usefulness/efficacy.
Should be considered.
Class IIb Usefulness/efficacy is less well
established by evidence/opinion.
May be considered.
Class III Evidence or general agreement that
the given treatment or procedure is
not useful/effective, and in some
cases may be harmful.
Is not recommended.
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Classes of recommendations
157 recommendations
I IIa
IIb
III
96
61%
37
24%
11
7% 13
8%
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Classes of recommendations
157 recommendations
I IIa
IIb
III
96
61%
37
24%
11
7% 13
8%
77
57% 31
23%
19
14%
8
6%
I
III
IIa
IIb
135 recommendations
in ESC 2008 GL
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Levels of evidence
Level of
Evidence A
Data derived from multiple randomized
clinical trials or meta-analyses.
Level of
Evidence B
Data derived from a single randomized
clinical trial or large non-randomized studies.
Level of
Evidence C
Consensus of opinion of the experts and/
or small studies, retrospective studies,
registries.
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Levels of evidence
21%
157 recommendations
based on 346 references 33 21%
55 35%
69 44%
A
B
C
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Levels of evidence
21%
157 recommendations
based on 346 references
30 22%
54 40%
51 38%
A
C
B
33 21%
55 35%
69 44%
A
B
C ESC 2008 GL
135 recommendations
based on 257 references
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
C
Levels of evidence
Remaining need for
research
69
44%
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
What is new?
• Early Diagnosis
• Expanded section, atypical presentations
• Cardiac Arrest
• Expanded section. The role of therapeutic hypothermia and angiography
defined.
• Pre Hospital Logistics of Care
• Role of pre hospital diagnosis, triage and networks highlighted
• Reperfusion strategies
• Modified recommended maximal time delays, angio post fibrinolysis
• PCI strategies
• Stent recommendations, anti thrombotic therapy
• Routine therapies and strategies
• Duration of hospital stay, secondary prevention, duration of anti thrombotic
therapy, Evaluation of LV function and viability
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Cardiac arrest
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Components of delay in STEMI and ideal
time intervals for intervention
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Prehospital and in-hospital management, and
reperfusion strategies within 24 h of FMC
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Important delays and treatment goals in the
management of acute STEMI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Reperfusion therapy
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Procedural aspects of primary PCI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Periprocedural anti thrombotic medication in
primary PCI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Periprocedural anti thrombotic medication in
primary PCI, con’t
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Periprocedural anti thrombotic medication in
primary PCI, con’t
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Routine therapies in the acute, subacute
and long term phase of STEMI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Routine therapies in the acute, subacute
and long term phase of STEMI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
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