Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology

Cardiovascular diseases are presently the leading causes of death in industrialized countries and expected to become so in emerging countries by 2020.1 Among these, coronary artery disease (CAD) is the most prevalent manifestation and is associated with high mortality and morbidity. The clinical presentations of ischaemic heart disease include silent ischaemia, stable angina pectoris, unstable angina, myocardial infarction (MI), heart failure, and sudden death. Patients with chest pain represent a very large proportion of all acute medical hospitalizations in Europe. Distinguishing those with acute coronary syndrome (ACS) within the very large proportion with suspected cardiac pain represents a diagnostic challenge, especially in those without clear symptoms or electrocardiographic features. In spite of modern treatment, the rates of death, MI, and re-admission of patients with ACS remain high.

It is well established that ACS in their different clinical presentations share a widely common pathophysiological substrate. Pathological, angioscopic, and biological observations have demonstrated that atherosclerotic plaque rupture or erosion, with differing degrees of superimposed thrombosis and distal embolization, resulting in myocardial underperfusion, represent the basic pathophysiological mechanisms in most ACS. [...]