TRIM: 89332
Evidence Sources:
Consultation Draft Clinical Care Standard
for Acute Coronary Syndrome
December 2013
Acknowledgements
Many individuals and organisations have freely given their time, expertise and documentation in the development of this paper. In
particular, the Commission wishes to thank the Acute Coronary Syndrome Working Group and other key experts who have given
their time and advice. The involvement and willingness of all concerned to share their experience and expertise is greatly
appreciated
Evidence Sources – Consultation Draft Clinical Care
Standard for Acute Coronary Syndrome
The development of quality statements of the Clinical Care Standard for Acute Coronary Syndrome (ACS)
has been based on the best available evidence, which includes existing national and international
guidelines and/or standards.
Within Australia, this includes two key publications that comprise nationally accepted guidelines for the
management of ACS:

The Guidelines for the Management of Acute Coronary Syndromes 2006, by the National Heart
Foundation of Australia and The Cardiac Society of Australia and New Zealand

The 2011 Addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and
New Zealand Guidelines for the Management of Acute Coronary Syndromes (ACS) 2006.
A number of data sources were accessed to locate relevant literature. They included:

existing guideline clearing houses such as the Agency for Healthcare Research and Quality (AHRQ),
Guidelines International Network (GIN) and National Health and Medical Research Council (NHMRC)

the Cochrane Collaboration for systematic literature reviews

internet searches were carried out on various international websites. This included guidelines or
standards published by recognised institutions such as National Institute for Health and Care
Excellence (NICE)

other relevant ACS literature was identified from England, Scotland, the United States of America, and
Europe.
Key search terms were used in website search engines, such as Google, to identify relevant papers. The
terms were: ST segment elevation myocardial infarction, non-ST segment elevation acute coronary
syndrome, non-ST segment elevation myocardial infarction, unstable angina and chest pain.
Only English version documents were considered as part of the literature scan. The searches took place
during the period February 2013 to August 2013. Once the relevant evidence sources were identified, a
summary of the evidence was then reviewed by ACS Topic Working Group members.
If there were no available guidelines or standards to support a quality statement the Commission then:

identified secondary evidence sources where possible e.g. national reports or published studies or
journals

drew on the consensus opinion of the ACS Topic Working Group. In such cases, this has been stated
within the Clinical Care Standard.
The list of evidence sources to support each quality statement for Acute Coronary Syndrome is current as
at August 2013.
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
1
Quality Statement 1
A patient with acute chest pain or other symptoms suggestive of an acute coronary
syndrome receives a 12-lead electrocardiogram (ECG) and the results are interpreted by
an ECG-qualified clinician within 10 minutes of first emergency clinical contact.
EVIDENCE SOURCES
Australian Guidelines
Acute Coronary Syndrome Guidelines Working Group. Guidelines for
the management of acute coronary syndromes 2006. Medical
Journal of Australia 2006;184(8):S1-S32 (pp. S7, S11).
Accessed March 2013 at https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromes2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c
International Guidelines
Anderson JL, Adams CD, Antman EM et al. ACC/AHA 2007 guidelines for the
management of patients with unstable angina/non–ST-elevation myocardial
infarction: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Circulation 2007;116(7):e148e304 (pp.e155, e161, e164-5).
Accessed March 2013 at
http://circ.ahajournals.org/content/116/7/e148.full.pdf+html?sid=720cf7c2-64c2-40ee-a3602d5879b8ab4a
Australian Resuscitation Council & New Zealand Resuscitation
Council. Acute coronary syndromes: presentation with ACS. ARC and
NZRC Guideline 2011. Emergency Medicine Australasia
2011;23(3):302-307 (pp.302).
Hamm C, Bassand JP, Agewall S et al. ESC guidelines for the management of
acute coronary syndromes in patients presenting without persistent STsegment elevation. European Heart Journal 2011;32:2999-3054 (pp.3005,
3041).
Accessed March 2013 at
http://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2011.01422_18.x/abstract
Accessed March 2013 at http://eurheartj.oxfordjournals.org/content/32/23/2999.full.pdf
Non-ST-Elevation Acute Coronary Syndrome Guidelines Group and the New
Zealand Branch of the Cardiac Society of Australia and New Zealand. New
Zealand 2012 guidelines for the management of non ST-elevation acute
coronary syndromes. The New Zealand Medical Journal 2012;125(1357):122147 (pp.129).
Accessed March 2013 at
http://www.csanz.edu.au/LinkClick.aspx?fileticket=34ukcSs__Cg%3d&tabid=148
SIGN. Acute Coronary Syndromes. Edinburgh: Scottish Intercollegiate
Guideline Network, 2013 (p.4).
Accessed March 2013 at http://www.sign.ac.uk
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
2
Quality Statement 1
EVIDENCE SOURCES
Australian Guidelines
A patient with acute chest pain or other symptoms suggestive of an acute coronary
syndrome receives a 12-lead electrocardiogram (ECG) and the results are interpreted by
an ECG-qualified clinician within 10 minutes of first emergency clinical contact.
International Guidelines
Steg P, James SK, Atar D et al. ESC guidelines for the management of acute
myocardial infarction in patients presenting with ST-segment elevation.
European Heart Journal 2012;33:2569-2619 (pp.2575-6, 2579).
Accessed March 2013 at http://www.escardio.org/guidelines-surveys/escguidelines/GuidelinesDocuments/Guidelines_AMI_STEMI.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
3
Quality Statement 2
A patient with an acute ST segment elevation myocardial infarction (STEMI), for whom
emergency reperfusion is clinically appropriate, receives primary percutaneous
coronary intervention (PCI) or thrombolysis within time frames recommended by the
current National Heart Foundation of Australia/Cardiac Society of Australia and New
Zealand Guidelines for the Management of Acute Coronary Syndrome.
EVIDENCE SOURCES
Australian Guidelines
Acute Coronary Syndrome Guidelines Working Group. Guidelines for
the management of acute coronary syndromes 2006. Medical
Journal of Australia 2006;184(8):S1-S32 (pp. S12 -18).
Accessed March 2013 at https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromes2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c
International Guidelines
O'Gara P, Kushner FG, Ascheim DD et al. ACCF/AHA guideline for the
management of ST-elevation myocardial infarction: A report of the American
College of Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. Circulation 2013;127:e362-e425 (pp.e370-e374).
Accessed March 2013 at http://circ.ahajournals.org/content/127/4/e362.full.pdf+html
Australian Resuscitation Council & New Zealand Resuscitation
Council. Acute coronary syndromes: presentation with ACS. ARC and
NZRC Guideline 2011. Emergency Medicine Australasia
2011;23(3):302-307 (pp.312).
NICE. Myocardial Infarction With ST-segment Elevation: The Acute
Management of Myocardial Infarction With ST-Segment Elevation: NICE
Clinical Guideline 167. National Institute for Health and Care Excellence, 2013
(pp.42-88; 200-207).
Accessed March 2013 at http://onlinelibrary.wiley.com/doi/10.1111/j.17426723.2011.01422_20.x/abstract
Accessed March 2013 at http://www.nice.org.uk/nicemedia/live/14208/64386/64386.pdf
SIGN. Acute Coronary Syndromes. Edinburgh: Scottish Intercollegiate
Guideline Network, 2013 (pp.12-13).
Accessed March 2013 at http://www.sign.ac.uk
Steg P, James SK, Atar D et al. ESC guidelines for the management of acute
myocardial infarction in patients presenting with ST-segment elevation.
European Heart Journal 2012;33:2569-2619 (pp.2580-2582, 2586 – 2588).
Accessed March 2013 at http://www.escardio.org/guidelines-surveys/escguidelines/GuidelinesDocuments/Guidelines_AMI_STEMI.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
4
Quality Statement 3
A patient presenting with acute chest pain or other symptoms suggestive of an acute
coronary syndrome receives care guided by an evidence-based clinical pathway
Consensus opinion:
The Acute Coronary Syndrome Topic Working Group agreed, by consensus, that patients presenting with acute chest pain, or other symptoms
suggestive of an acute coronary syndrome, receive care guided by an evidence-based clinical pathway. This should also include patients whose initial
presentation does not allow a definitive diagnosis of acute coronary syndrome.
EVIDENCE SOURCES
Australian Guidelines
Acute Coronary Syndrome Guidelines Working Group.
Guidelines for the management of acute coronary
syndromes 2006. Medical Journal of Australia
2006;184(8):S1-S32 (pp. S11 -13).
Accessed March 2013 at
https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromes2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c
Australian Resuscitation Council & New Zealand
Resuscitation Council. Acute coronary syndromes:
presentation with ACS. ARC and NZRC Guideline 2011.
Emergency Medicine Australasia 2011;23(3):302-307
(pp. 303).
International Guidelines
Additional Sources
NICE. Chest Pain of Recent Onset:
Assessment and Diagnosis of Recent Onset
Chest Pain or Discomfort of Suspected
Cardiac Origin: NICE Clinical Guideline 95.
National Institute for Health and Care
Excellence, 2010.
NSW Health, Chest Pain Evaluation (NSW
Chest Pain Pathway). North Sydney: NSW
Department of Health, 2010.
Accessed March 2013 at
http://www0.health.nsw.gov.au/policies/pd/2011/p
df/PD2011_037.pdf
Accessed March 2013 at
http://www.nice.org.uk/nicemedia/live/12947/4793
8/47938.pdf
Accessed March 2013 at
http://onlinelibrary.wiley.com/doi/10.1111/j.17426723.2011.01422_18.x/abstract
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
5
Quality Statement 4
EVIDENCE SOURCES
Australian Guidelines
A patient admitted to hospital with a non-ST segment elevation acute coronary
syndrome (NSTEACS) is managed based on a documented, evidence-based assessment
of their risk of major adverse cardiac events.
International Guidelines
Acute Coronary Syndrome Guidelines Working Group.
Guidelines for the management of acute coronary
syndromes 2006. Medical Journal of Australia
2006;184(8):S1-S32 (pp. S20 – S22).
Anderson JL, Adams CD, Antman EM et al.
ACC/AHA 2007 guidelines for the
management of patients with unstable
angina/non–ST-elevation myocardial
infarction: A report of the American College
Accessed March 2013 at
of Cardiology/American Heart Association
https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromesTask Force on Practice Guidelines. Circulation
2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c 2007;116(7):e148-e304 (pp.e163-165, e178).
Accessed March 2013 at
http://circ.ahajournals.org/content/116/7/e148.full.pdf
+html?sid=720cf7c2-64c2-40ee-a360-2d5879b8ab4a
Australian Resuscitation Council & New Zealand
Resuscitation Council. Acute coronary syndromes:
presentation with ACS. ARC and NZRC Guideline 2011.
Emergency Medicine Australasia 2011;23(3):302-307
(pp.303).
Accessed March 2013 at
http://onlinelibrary.wiley.com/doi/10.1111/j.17426723.2011.01422_18.x/abstract
Additional Sources
NHFA & CSANZ. Acute Coronary
Syndromes Treatment Algorithm.
National Heart Foundation of Australia
and Cardiac Society of Australia and New
Zealand, 2011.
Accessed March 2013 at
http://www.heartfoundation.org.au/SiteCollection
Documents/ACS%20therapy%20algorithm-WEBsecure.pdf
Hamm C, Bassand JP, Agewall S et al. ESC
guidelines for the management of acute
coronary syndromes in patients presenting
without persistent ST-segment elevation.
European Heart Journal 2011;32:2999-3054
(pp.3008-11, 3041-2).
Accessed March 2013 at
http://eurheartj.oxfordjournals.org/content/32/23/299
9.full.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
6
Quality Statement 4
EVIDENCE SOURCES
Australian Guidelines
A patient admitted to hospital with a non-ST segment elevation acute coronary
syndrome (NSTEACS) is managed based on a documented, evidence-based assessment
of their risk of major adverse cardiac events.
International Guidelines
Additional Sources
NICE. Unstable Angina and NSTEMI: The Early
Management of Unstable Angina and NonST-Segment-Elevation Myocardial Infarction:
NICE Clinical Guideline 94. National Institute
for Health and Clinical Excellence, 2010
(pp.34-68).
Accessed March 2013 at
http://www.nice.org.uk/nicemedia/live/12949/47988/
47988.pdf
Non-ST-Elevation Acute Coronary Syndrome
Guidelines Group and the New Zealand
Branch of the Cardiac Society of Australia and
New Zealand. New Zealand 2012 guidelines
for the management of non ST-elevation
acute coronary syndromes. The New Zealand
Medical Journal 2012;125(1357):122-147
(pp.123-129).
Accessed March 2013 at
http://www.csanz.edu.au/LinkClick.aspx?fileticket=34u
kcSs__Cg%3d&tabid=148
SIGN. Acute Coronary Syndromes. Edinburgh:
Scottish Intercollegiate Guideline Network,
2013 (pp.17).
Accessed March 2013 at http://www.sign.ac.uk
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
7
Quality Statement 5
EVIDENCE SOURCES
Australian Guidelines
The role of coronary angiography with a view to appropriate coronary revascularisation
is considered and discussed with a patient with a non-ST segment elevation acute
coronary syndrome (NSTEACS) who is assessed to be at intermediate or high risk of an
adverse cardiac event.
International Guidelines
Acute Coronary Syndrome Guidelines Working Group.
Guidelines for the management of acute coronary
syndromes 2006. Medical Journal of Australia
2006;184(8):S1-S32 (pp. S21).
Anderson JL, Adams CD, Antman EM et al.
ACC/AHA 2007 guidelines for the
management of patients with unstable
angina/non–ST-elevation myocardial
infarction: A report of the American College
Accessed March 2013 at
of Cardiology/American Heart Association
https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromesTask Force on Practice Guidelines.
2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c Circulation 2007;116(7):e148-e304
(pp.e219, e230).
Additional Sources
Hoenig MR, Aroney CN, Scott IA. Early
invasive versus conservative strategies for
unstable angina and non-ST elevation
myocardial infarction in the stent era.
Cochrane Database of Systematic Reviews
2010 Issue 3:CD004815.
Accessed March 2013 at
http://dx.doi.org/10.1002/14651858.CD004815.pub3
Accessed March 2013 at
http://circ.ahajournals.org/content/116/7/e148.full.
pdf+html?sid=720cf7c2-64c2-40ee-a3602d5879b8ab4a
Hamm C, Bassand JP, Agewall S et al. ESC
guidelines for the management of acute
coronary syndromes in patients presenting
without persistent ST-segment elevation.
European Heart Journal 2011;32:2999-3054
(pp.3027-30, 3044).
Accessed March 2013 at
http://eurheartj.oxfordjournals.org/content/32/23/2
999.full.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
8
Quality Statement 5
EVIDENCE SOURCES
Australian Guidelines
The role of coronary angiography with a view to appropriate coronary revascularisation
is considered and discussed with a patient with a non-ST segment elevation acute
coronary syndrome (NSTEACS) who is assessed to be at intermediate or high risk of an
adverse cardiac event.
International Guidelines
Additional Sources
Jneid H, Anderson JL, Wright RD et al. 2012
ACCF/AHA focused update on the guideline
for the management of patients with
unstable angina/non-ST-elevation
myocardial infarction. Circulation
2012;126:875-910 (pp.890).
Accessed March 2013 at
http://circ.ahajournals.org/content/126/7/875.full.p
df+html
NICE. Unstable Angina and NSTEMI: the
Early Management of Unstable Angina and
Non-ST-Segment-Elevation Myocardial
Infarction: NICE Clinical Guideline 94.
National Institute for Health and Clinical
Excellence, 2010 (pp.169-199).
Accessed March 2013 at
http://www.nice.org.uk/nicemedia/live/12949/4798
8/47988.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
9
Quality Statement 5
EVIDENCE SOURCES
Australian Guidelines
The role of coronary angiography with a view to appropriate coronary revascularisation
is considered and discussed with a patient with a non-ST segment elevation acute
coronary syndrome (NSTEACS) who is assessed to be at intermediate or high risk of an
adverse cardiac event.
International Guidelines
Additional Sources
Non-ST-Elevation Acute Coronary
Syndrome Guidelines Group and the New
Zealand Branch of the Cardiac Society of
Australia and New Zealand. New Zealand
2012 guidelines for the management of
non ST-elevation acute coronary
syndromes. The New Zealand Medical
Journal 2012;125(1357):122-147 (pp.135137).
Accessed March 2013 at
http://www.csanz.edu.au/LinkClick.aspx?fileticket=3
4ukcSs__Cg%3d&tabid=148
SIGN. Acute Coronary Syndromes.
Edinburgh: Scottish Intercollegiate
Guideline Network, 2013 (pp.19)
Accessed March 2013 at http://www.sign.ac.uk
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
10
Quality Statement 6
EVIDENCE SOURCES
Australian Guidelines
Before a patient with an acute coronary syndrome leaves the hospital, they are
involved in developing an individualised care plan that identifies the lifestyle
modifications and medicines they should take to manage their risk factors, addresses
their psychosocial needs and includes a referral to a cardiac rehabilitation program that
is appropriate for them. This plan is also provide to the patient’s general practitioner.
International Guidelines
Acute Coronary Syndrome Guidelines Working Group.
Guidelines for the management of acute coronary
syndromes 2006. Medical Journal of Australia
2006;184(8):S1-S32 (pp. S23 – 24).
Anderson JL, Adams CD, Antman EM et al.
ACC/AHA 2007 guidelines for the
management of patients with unstable
angina/non–ST-elevation myocardial
infarction: A report of the American College
Accessed March 2013 at
of Cardiology/American Heart Association
https://www.mja.com.au/journal/2006/184/8/guidelinesmanagement-acute-coronary-syndromesTask Force on Practice Guidelines.
2006?0=ip_login_no_cache%3D3d22f95f326892c5ec2ab39ec8e8826c Circulation 2007;116(7):e148-e304
(pp.e237).
Additional Sources
ACSQHC. Australian Safety and Quality
Framework for Health Care. Sydney:
Australian Commission on Safety and
Quality in Health Care, 2010.
Accessed March 2013 at
http://www.safetyandquality.gov.au/wpcontent/uploads/2012/04/Australian-SandQFramework1.pdf
Accessed March 2013 at
http://circ.ahajournals.org/content/116/7/e148.full.
pdf+html?sid=720cf7c2-64c2-40ee-a3602d5879b8ab4a
Hamm C, Bassand JP, Agewall S et al. ESC
guidelines for the management of acute
coronary syndromes in patients presenting
without persistent ST-segment elevation.
European Heart Journal 2011;32:2999-3054
(pp.3038-3040, 3044).
Accessed March 2013 at
http://eurheartj.oxfordjournals.org/content/32/23/2
999.full.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
Briffa TG, Kinsman L, Maioran AJ et al. An
integrated and coordinated approach to
preventing recurrent coronary heart
disease events in Australia. Medical
Journal of Australia 2009;190(12):683-686.
Accessed March 2013 at
https://www.mja.com.au/journal/2009/190/12/integ
rated-and-coordinated-approach-preventingrecurrent-coronary-heart-disease
11
Quality Statement 6
EVIDENCE SOURCES
Australian Guidelines
Before a patient with an acute coronary syndrome leaves the hospital, they are
involved in developing an individualised care plan that identifies the lifestyle
modifications and medicines they should take to manage their risk factors, addresses
their psychosocial needs and includes a referral to a cardiac rehabilitation program that
is appropriate for them. This plan is also provide to the patient’s general practitioner.
International Guidelines
Additional Sources
O'Gara P, Kushner FG, Ascheim DD et al.
ACCF/AHA guideline for the management
of ST-elevation myocardial infarction: A
report of the American College of
Cardiology Foundation/American Heart
Association Task Force on Practice
Guidelines. Circulation 2013;127:e362-e425
(pp.e399).
NHFA & ACRA. Recommended Framework
for Cardiac Rehabilitation 2004. National
Heart Foundation of Australia and
Australian Cardiac Rehabilitation
Association, 2004.
Accessed March 2013 at
http://www.heartfoundation.org.au/SiteCollectionD
ocuments/Recommended-framework.pdf
Accessed March 2013 at
http://circ.ahajournals.org/content/127/4/e362.full.
pdf+html
NICE. Unstable Angina and NSTEMI: the
Early Management of Unstable Angina and
Non-ST-Segment-Elevation Myocardial
Infarction: NICE Clinical Guideline 94.
National Institute for Health and Clinical
Excellence, 2010 (pp.234-241)
Accessed March 2013 at
http://www.nice.org.uk/nicemedia/live/12949/4798
8/47988.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
12
Quality Statement 6
EVIDENCE SOURCES
Australian Guidelines
Before a patient with an acute coronary syndrome leaves the hospital, they are
involved in developing an individualised care plan that identifies the lifestyle
modifications and medicines they should take to manage their risk factors, addresses
their psychosocial needs and includes a referral to a cardiac rehabilitation program that
is appropriate for them. This plan is also provide to the patient’s general practitioner.
International Guidelines
Additional Sources
Non-ST-Elevation Acute Coronary
Syndrome Guidelines Group and the New
Zealand Branch of the Cardiac Society of
Australia and New Zealand. New Zealand
2012 guidelines for the management of
non ST-elevation acute coronary
syndromes. The New Zealand Medical
Journal 2012;125(1357):122-147 (pp.138).
Accessed March 2013 at
http://www.csanz.edu.au/LinkClick.aspx?fileticket=3
4ukcSs__Cg%3d&tabid=148
SIGN. Acute Coronary Syndromes.
Edinburgh: Scottish Intercollegiate
Guideline Network, 2013 (pp.29).
Accessed March 2013 at http://www.sign.ac.uk
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
13
Quality Statement 6
EVIDENCE SOURCES
Australian Guidelines
Before a patient with an acute coronary syndrome leaves the hospital, they are
involved in developing an individualised care plan that identifies the lifestyle
modifications and medicines they should take to manage their risk factors, addresses
their psychosocial needs and includes a referral to a cardiac rehabilitation program that
is appropriate for them. This plan is also provide to the patient’s general practitioner.
International Guidelines
Additional Sources
Smith CJ, Benjamin EJ, Bonow RO et al.
AHA/ACCF secondary prevention and risk
reduction therapy for patients with
coronary and other atherosclerotic vascular
disease: 2011 update: a guideline from the
American Heart Association and American
College of Cardiology Foundation.
Circulation 2011;124:2458-2473.
Accessed March 2013 at
http://circ.ahajournals.org/content/124/22/2458.full
.pdf+html?sid=cf38ade9-3333-4332-b813de9410db1d7f
Steg P, James SK, Atar D et al. ESC
guidelines for the management of acute
myocardial infarction in patients presenting
with ST-segment elevation. European Heart
Journal 2012;33:2569-2619 (pp.25952596).
Accessed March 2013 at
http://www.escardio.org/guidelines-surveys/escguidelines/GuidelinesDocuments/Guidelines_AMI_ST
EMI.pdf
Evidence Sources: Consultation Draft Clinical Care Standard for Acute Coronary Syndrome
14