Acute Coronary Syndrome Requires (or Not) an Immediate Reperfusion Strategy: It Is Time to Change the Paradigm

Proposed new classification for acute coronary syndrome: Acute coronary syndrome requiring immediate reperfusion

“…This pattern is associated with a critical lesion in the left anterior descending artery which, as originally described, develops acute anterior myocardial infarction in 75% of cases if they are not reperfused and could develop a STEMI in the next few hours. 30 and ST elevation alone may not completely identify those at the highest risk 33 (Figure 1). In some cases, complementary tools that are immediately available may be useful to approach the diagnosis of ACS and reperfusion strategy.…”

“…It is for this reason, we suggest a new approach to ACS, beyond the ST segment changes. Identification of the correct patients who require immediate reperfusion (RIR) versus those who do not (non‐RIR) is essential, and ST elevation alone may not completely identify those at the highest risk 33 (Figure 1). In some cases, complementary tools that are immediately available may be useful to approach the diagnosis of ACS and reperfusion strategy.…”