Коментуючи проблемні питання гострого коронарного синдрому в світлі рекомендацій 2023

The recommendations for the diagnosis and treatment of acute coronary syndrome (ACS), published by the European Society of Cardiology in 2023, have become a powerful tool in the management of patients with destabilized coronary heart disease, in which ACS is often the debut of the disease. The purpose of the review was to familiarize the general public with the new postulates of the European Society of Cardiology Recommendations (2023) on diagnosis and routing of a patient with an acute coronary syndrome. A comparative analysis was conducted of the key provisions of European guidelines of recent years regarding the initial stage of management of a patient with ACS. In the guidelines of the European Society of Cardiology (2023), much attention is paid to gender differences in cardiac and extracardiac symptoms in the clinical picture of ACS. The proposed diagnostic methods proved to be valid and accessible, quickly reproducible. A clear patient routing plan is presented in various scenarios of ACS, taking into account risk stratification. When choosing a reperfusion method in patients with ST-elevation myocardial infarction, emphasis is placed on reducing the time of total ischemia from first medical contact during self-referral or when an ambulance is called. Risk stratification is perhaps the most important when choosing the tactics of managing a patient with ACS without ST segment elevation. In the combined guidelines, the routine ECG remains the fastest, most reproducible method for diagnosing acute coronary syndrome.For the first time in the presented edition of the document, in the high-risk group with non ST-elevation ACS, the spectrum of ECG manifestations has been expanded, which can potentially indicate the most unfavorable course, requiring urgent coronary angiography to clarify the anatomy and volume of the lesion. The role of highly sensitive methods of laboratory diagnostics, in particular troponin in a specific time period, is clarified. Attention is drawn to the lack of dynamism of its values in many other urgent conditions, which often complicates differential diagnosis. Conducting an echocardiogram in case of complicated ACS should not affect the time of delivery of the patient to the catheterization laboratory. Modern diagnostic methods such as magnetic resonance imaging, optical coherence tomography, intravascular ultrasound are emphasized. The combination of recommendations from various forms of GCS in one document simplified the perception of general approaches to the management of this category of patients to a certain extent. The main goal of ACS management in the initial stages of management remains the early restoration of coronary blood flow.