High-risk non-ST elevation acute coronary syndromes (NSTEACS) for paramedics

Ischaemic heart disease (IHD) is the leading cause of death worldwide with 12.8% of all deaths attributed to this (World Health Organization (WHO), 2011). A number of IHD patients may also develop an acute coronary syndrome (ACS). Ambulance clinicians commonly encounter patients suffering ACS, this being unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).

Differentiating between the three can be challenging, however with good history from the patient, including history of the complaint along with established cardiac risk factors, familial history and a good understanding of electrocardiograms (ECGs), differentiating between STEMI and Non ST elevation acute coronary syndromes (NSTEACS) can be clinically suspected and achieved with blood biomarker assays.However, all three types of ACS would warrant the same drug therapy from paramedics and currently only STEMI patients attend heart attack centres (HACs) as standard practice where the patients may undergo primary percutaneous coronary intervention (pPCI). These patients undergo an assessment by a cardiologist and angiography commonly followed by re-vascularisation and stent insertion if required to open up the affected coronary artery/s. NSTEACS patients could be seen to be pre-STEMI as their stenosis may be critical and may develop into a STEMI, therefore benefiting from early expert opinion to optimise future heart function and if required revascularisation.