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. 2024 Jul 11:29:32.
doi: 10.4103/jrms.jrms_851_23. eCollection 2024.

Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome

Nizal Sarrafzadegan  1   2 , Fahimeh Bagherikholenjani  1 , Shahla Shahidi  1 , Golsa Ghasemi  3 , Ehsan Shirvani  2   4 , Fatemeh Rajati  5 , Farid Najafi  6 , Samad Ghaffari  2   7 , Alireza Khosravi  2   8 , Ahmadreza Assareh  2   9 , Seyed Mohammad Hassan Adel  2   10 , Javad Kojuri  2   11 , Niloufar Samiei  2   12 , Farzad Masoudkabir  2   13 , Hossein Farshidi  2   14 , Mohammad Kermani-Alghoraishi  2   4 , Masoumeh Sadeghi  2   15 , Davood Shafei  2   16 , Masoumeh Jorjani  17 , Mansour Siavash  18 , Fariborz Khorvash  19 , Mehdi Nasr Isfahani  20 , Behzad Fatemi  21 , Majid Davari  21 , Mitra Moradinia  22 , Ramesh Hoseinkhani  23 , Valiollah Hajhashemi  24 , Noushin Mohammadifard  25 , Majid Ghayour Mobarhan  26 , Ali Momeni  27 , Mojgan Mortazavi  3 , Mohammad Akbari  28 , Fereshteh Sattar  29 , Fereidoun Noohi  2   30 , Maryam Kheiri  31 , Mosa Tabatabaeilotfi  32 , Sanaz Bakhshandeh  32 , Parisa Janjani  33 , Sajad Fakhri  34 , Alireza Abdi  35
Affiliations

Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome

Nizal Sarrafzadegan et al. J Res Med Sci. .

Abstract

Background: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran.

Materials and methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline.

Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease.

Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans.

Keywords: Acute coronary syndrome; ST-elevation myocardial infarction; clinical practice guideline; non-ST-elevation myocardial infarction; unstable angina.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Analytical Framework of ACS
Figure 2
Figure 2
Dealing with a patient with chest pain (patient suspected of acute coronary syndrome)
Figure 3
Figure 3
Flowchart of ACS treatment
Figure 4
Figure 4
Manage people with ACS and Cardiogenic Shock (CS)
Figure 5
Figure 5
MINOCA Management Chart
Figure 6
Figure 6
Flowchart of Secondary prevention and rehabilitation after ACS treatment
See this image and copyright information in PMC

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