What are the class I recommendations for prehospital diagnostic intervention in patients with ACS?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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The 2015 guidelines include the following class I recommendations for prehospital diagnostic intervention [43] :

  • 12-Lead ECG should be acquired early for patients with possible ACS

  • Notification of the receiving hospital (if fibrinolysis is the likely reperfusion strategy) and/or prehospital activation of the catheterization laboratory should occur for all patients with a recognized STEMI on ECG

  • If providers are not trained to interpret the 12-lead ECG, field transmission of the ECG or a computer report should be sent to the receiving hospital

  • 12-Lead ECG diagnostic programs should be implemented with concurrent medically directed quality assurance

Additional recommendations include the following [43] :

  • Negative high-sensitivity cardiac troponin (hs-cTn) and cardiac-specific troponin I (cTnI) levels during initial patient evaluation should not be used as a standalone measure to exclude an ACS (class III)

There are no significant variances in the ERC and ILCOR recommendations. [52, 59]

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