• Nizal Sarrafzadegan, Fahimeh Bagherikholenjani, Shahla Shahidi, Golsa Ghasemi, Ehsan Shirvani, Fatemeh Rajati, Farid Najafi, Samad Ghaffari, Alireza Khosravi, Ahmadreza Assareh, AdelSeyed Mohammad HassanSMHIranian Network of Cardiovascular Research, Tehran, Iran.Department of Cardiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran., Javad Kojuri, Niloufar Samiei, Farzad Masoudkabir, Hossein Farshidi, Mohammad Kermani-Alghoraishi, Masoumeh Sadeghi, Davood Shafei, Masoumeh Jorjani, Mansour Siavash, Fariborz Khorvash, IsfahaniMehdi NasrMNDepartment of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran., Behzad Fatemi, Majid Davari, Mitra Moradinia, Ramesh Hoseinkhani, Valiollah Hajhashemi, Noushin Mohammadifard, Majid Ghayour Mobarhan, Ali Momeni, Mojgan Mortazavi, Mohammad Akbari, Fereshteh Sattar, Fereidoun Noohi, Maryam Kheiri, Mosa Tabatabaeilotfi, Sanaz Bakhshandeh, Parisa Janjani, Sajad Fakhri, and Alireza Abdi.
• Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
• J Res Med Sci. 2024 Jan 1; 29: 3232.

BackgroundThis article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran.Materials And MethodsThe 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.ResultsThe 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.ConclusionDeveloping 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.Copyright: © 2024 Journal of Research in Medical Sciences.

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