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Recomendación 1:
En los pacientes con sospecha de síndrome coronario agudo se recomienda que sean evaluados inmediatamente por un profesional de la salud competente y debe realizársele un electrocardiograma de 12 derivaciones. (Recomendación fuerte a favor)

Recomendación 2:
Se sugiere que las concentraciones de troponina se midan al ingreso y 12 horas después del inicio de los síntomas para establecer el pronóstico de infarto de miocardio. (Recomendación condicional a favor)

BPC 1:
Se recomienda que la toma del electrocardiograma se realice e interprete dentro de los primeros 10 minutos de contacto con el médico/llegada al hospital.

BPC 2:
Se recomienda repetir electrocardiogramas de 12 derivaciones si el diagnóstico es incierto o se produce un cambio en el estado del paciente, y antes del alta del hospital.

BPC 3:
En los pacientes con Bloqueo de rama o cambios en el ST persistentes que no cumplan con criterios de SCA se recomienda que se les entregue una copia de su electrocardiograma para ayudar en el manejo clínico futuro si vuelven a presentar un cuadro clínico sospechoso de síndrome coronario agudo.

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Recomendación 1:
Los pacientes con síndrome coronario agudo deben tener monitoreo continuo del ritmo cardiaco y proximidad a un desfibrilador. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 2:
En presencia de cambios isquémicos electrocardiográficos, los pacientes con síndrome coronario agudo deben ser tratados inmediatamente con: aspirina (300 mg de dosis carga) y clopidogrel (300 mg de dosis carga para pacientes ˂75 años, 75 mg para pacientes > 75 años), o ticagrelor (180 mg de dosis carga) en quienes se someterán a intervención coronaria percutánea primaria dentro de los 120 minutos desde el diagnostico electrocardiográfico. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 3:
Para los pacientes con síndrome coronario agudo, en quienes los riesgos del uso de ticagrelor (sangrado) superan los beneficios (reducción de recurrencia de eventos aterotrombóticos), se puede considerar aspirina (300 mg de dosis carga) y clopidogrel (300 mg de dosis carga para pacientes ˂75 años, 75 mg para pacientes > 75 años). (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 4:
Debe administrarse aspirina (162 a 325 mg dosis carga) y clopidogrel (300 mg de dosis carga para pacientes ˂75 años, 75 mg para pacientes > 75 años) en pacientes con síndrome coronario agudo ST elevado que reciben terapia fibrinolítica. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 5:
Aspirina debe continuarse indefinidamente y clopidogrel (75 mg diarios) debería continuarse por al menos 14 días en pacientes con síndrome coronario agudo ST elevado que recibió terapia fibrinolítica. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 6:
Los pacientes con SCA ST elevado que reciben terapia de reperfusión o no, deben ser tratados inmediatamente con heparina no fraccionada o heparina de bajo peso molecular. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 7:
Los pacientes con SCA con elevación del ST deberían ser tratados inmediatamente con ICP primaria. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 8:
Deben desarrollarse protocolos locales para el tratamiento rápido de los pacientes que presentan SCA con elevación del ST. Se debe considerar transferir de emergencia a los pacientes hacia centros con capacidad de ICP primaria. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 9:
La implantación del stent coronario debería ser usada en pacientes que reciben ICP. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 10:
La trombectomía no debería ser usada de manera rutinaria durante la ICP primaria. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 11:
Cuando la ICP primaria no puede ser provista dentro de los 120 minutos del diagnóstico electrocardiográfico, los pacientes con SCA con elevación del ST deberían recibir terapia trombolítica inmediata (prehospitalaria o a su admisión). (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 12:
La trombólisis debería ser hecha con un agente fibrino-específico. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 13:
La transferencia a un hospital capaz de realizar ICP para angiografía coronaria es razonable para los pacientes con síndrome coronario agudo ST elevado que recibieron terapia fibrinolítica incluso cuando ya se encuentren hemodinámicamente estables y con evidencia clínica de reperfusión. La angiografía debe realizarse tan pronto sea logísticamente factible en el hospital con capacidad de ICP e idealmente dentro de las primeras 24 horas, pero no debe realizarse en las primeras 3 horas de la administración del trombolítico (estrategia fármacoinvasiva). (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 14:
Los pacientes que presentan SCA ST elevado en quienes la terapia trombolítica es fallida, deberían ser considerados para ICP de rescate y ser transferidos a un centro con capacidad de ICP. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 15:
pacientes con síndrome coronario agudo con elevación del ST tratados con terapia trombolítica exitosa deben ser considerados para angiografía coronaria y revascularización temprana. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 16:
En pacientes con síndrome coronario agudo, el acceso vascular de elección para realizar la ICP debe ser la arteria radial. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 17:
Los pacientes con síndrome coronario agudo confirmado y diabetes mellitus o hiperglicemia marcada (>11.0 mmol/L=200 mg/dl) deben tener un control inmediato de la glucosa con el valor objetivo de 7.0 a 10.9 mmol/L (126 a 196 mg/dl). (Recomendación fuerte a favor, certeza muy baja de la evidencia)

BPC 1:
Los pacientes con síndrome coronario agudo deben ser manejados en un hospital que cuente con capacidad de reperfusión: Intervención Coronaria Percutánea (ICP) o fibrinólisis.

BPC 2:
Ticagrelor no debería ser utilizado como adyuvante de fibrinólisis porque no ha sido estudiado en este escenario.

BPC 3:
La ICP primaria debería ser hecha por el centro con menor tiempo de transferencia para el paciente.

BPC 4:
Todos los centros deberían participar en auditorias constantes de tiempos y retrasos de tratamiento standard relacionado a ICP primaria.

BPC 4:
Los hospitales que adopten la intervención invasiva temprana para los pacientes con síndrome coronario agudo deben considerar el alta precoz en aquellos pacientes con bajo riesgo de eventos subsecuentes.

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Recomendación 1:
Después del SCA todos los pacientes deben mantenerse en terapia con aspirina a largo plazo. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 2:
Los pacientes con SCA deben recibir tratamiento antiplaquetario doble durante seis meses. Pueden utilizarse períodos más largos cuando los riesgos de acontecimientos aterotrombóticos superan el riesgo de sangrado. Pueden utilizarse períodos más cortos cuando los riesgos de sangrado superan el riesgo de episodios aterotrombóticos. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 3:
Los pacientes con SCA deben comenzar la terapia a largo plazo con estatinas antes del alta hospitalaria (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 4:
Los pacientes con SCA deben mantenerse en terapia con beta-bloqueadores a largo plazo. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 5:
Los pacientes con angina inestable deben comenzar el tratamiento a largo plazo con inhibidores de la enzima convertidora de la angiotensina. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 6:
Los pacientes con infarto de miocardio deben iniciar terapia con inhibidores de la ECA a largo plazo dentro de las primeras 36 horas. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 7:
Los pacientes con infarto de miocardio complicado por disfunción ventricular izquierda o insuficiencia cardíaca que son intolerantes a la terapia con inhibidores de la enzima convertidora de la angiotensina deben iniciar terapia con bloqueadores de receptor de angiotensina a largo plazo. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

Recomendación 8:
Se debe ofrecer evaluación e intervención psicosocial temprana a los pacientes con síndrome coronario agudo, con énfasis en la identificación y manejo de creencias de salud y conceptos cardiacos erróneos. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

BPC 1:
Se recomienda una dosis de 75 a 100 mg de aspirina al día en pacientes con SCA.

BPC 2:
Los nitratos deben utilizarse en pacientes con SCA para aliviar el dolor cardíaco debido a la isquemia miocárdica continua o para tratar la insuficiencia cardíaca aguda.

BPC 3:
La intervención psicosocial forma parte de los programas formales de rehabilitación cardiaca y deben ser vistos como un proceso continuo a lo largo del cuidado del paciente.

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Recomendación 1:

En los pacientes con sospecha de síndrome coronario agudo se recomienda que sean evaluados inmediatamente por un profesional de la salud competente y debe realizársele un electrocardiograma de 12 derivaciones. (Recomendación fuerte a favor)

Recomendación 2:
En pacientes con sospecha de síndrome coronario agudo, se sugiere medir las concentraciones de troponina sérica al inicio y a las 12 horas para guiar el manejo y tratamiento apropiados. (Recomendación condicional a favor)

BPC 1:
Se recomienda que la toma del electrocardiograma se realice e interprete dentro de los primeros 10 minutos de contacto con el médico/llegada al hospital.

BPC 2:
Se recomienda repetir electrocardiogramas de 12 derivaciones si el diagnóstico es incierto o se produce un cambio en el estado del paciente, y antes del alta del hospital.

BPC 3:
En los pacientes con Bloqueo de rama o cambios en el ST persistentes que no cumplan con criterios de SCA se recomienda que se les entregue una copia de su electrocardiograma para ayudar en el manejo clínico futuro si vuelven a presentar un cuadro clínico sospechoso de síndrome coronario agudo.

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Recomendación 1:
En personas adultas con exceso de peso y/o factores de riesgo cardiovascular se recomienda intervenciones intensas de asesoramiento conductual para la prevención de ECV. (Recomendación fuerte a favor, certeza moderada de la evidencia)

BCP 1:
Se sugiere realizar las intervenciones intensas de asesoramiento conductual a aquellas personas con los siguientes factores de riesgo: edad avanzada, presión arterial sistólica o diastólica elevada, fumador o exfumador, dislipidemia (colesterol total, LDL, triglicéridos elevados, o HDL disminuido), hipertrofia ventricular izquierda, diabetes mellitus y exceso de peso definido con un índice de masa corporal ≥ 30 Kg/m2 o con una circunferencia abdominal ≥ 102 cm en varones y ≥ 88 en mujeres.

BCP 2:
Se sugiere que la asesoría conductual tenga como objetivo el cambio de comportamientos dirigidos a una dieta saludable y actividad física regular. La asesoría conductual se realizará inicialmente con entrevistas motivacionales personales, complementadas con seguimiento periódico por vía telefónica y debates didácticos y abiertos en grupos pequeños. En ese sentido, la intervención deberá consistir en una educación didáctica, preparación para resolver problemas y dudas, y planes de atención individualizados, considerando la participación también de la familia y/o cuidadores del paciente en la asesoría conductual.

BPC 3:
Se sugiere que las intervenciones sean impartidas por profesionales especialmente capacitados, incluidos dietistas o nutricionistas, fisioterapeutas o profesionales del ejercicio, educadores de salud o psicólogos.

Descargar PDF con el desarrollo de la pregunta.

Recomendación 1:
En personas adultas con exceso de peso y/o factores de riesgo cardiovascular se recomienda intervenciones intensas de asesoramiento conductual para la prevención de ECV. (Recomendación fuerte a favor, certeza moderada de la evidencia)

BCP 1:
Se sugiere realizar las intervenciones intensas de asesoramiento conductual a aquellas personas con los siguientes factores de riesgo: edad avanzada, presión arterial sistólica o diastólica elevada, fumador o exfumador, dislipidemia (colesterol total, LDL, triglicéridos elevados, o HDL disminuido), hipertrofia ventricular izquierda, diabetes mellitus y exceso de peso definido con un índice de masa corporal ≥ 30 Kg/m2 o con una circunferencia abdominal ≥ 102 cm en varones y ≥ 88 en mujeres.

BCP 2:
Se sugiere que la asesoría conductual tenga como objetivo el cambio de comportamientos dirigidos a una dieta saludable y actividad física regular. La asesoría conductual se realizará inicialmente con entrevistas motivacionales personales, complementadas con seguimiento periódico por vía telefónica y debates didácticos y abiertos en grupos pequeños. En ese sentido, la intervención deberá consistir en una educación didáctica, preparación para resolver problemas y dudas, y planes de atención individualizados, considerando la participación también de la familia y/o cuidadores del paciente en la asesoría conductual.

BPC 3:
Se sugiere que las intervenciones sean impartidas por profesionales especialmente capacitados, incluidos dietistas o nutricionistas, fisioterapeutas o profesionales del ejercicio, educadores de salud o psicólogos.

Descargar PDF con el desarrollo de la pregunta.

Recomendación 1:
En personas adultas con exceso de peso y/o factores de riesgo cardiovascular se recomienda intervenciones intensas de asesoramiento conductual para la prevención de ECV. (Recomendación fuerte a favor, certeza moderada de la evidencia)

BCP 1:
Se sugiere realizar las intervenciones intensas de asesoramiento conductual a aquellas personas con los siguientes factores de riesgo: edad avanzada, presión arterial sistólica o diastólica elevada, fumador o exfumador, dislipidemia (colesterol total, LDL, triglicéridos elevados, o HDL disminuido), hipertrofia ventricular izquierda, diabetes mellitus y exceso de peso definido con un índice de masa corporal ≥ 30 Kg/m2 o con una circunferencia abdominal ≥ 102 cm en varones y ≥ 88 en mujeres.

BCP 2:
Se sugiere que la asesoría conductual tenga como objetivo el cambio de comportamientos dirigidos a una dieta saludable y actividad física regular. La asesoría conductual se realizará inicialmente con entrevistas motivacionales personales, complementadas con seguimiento periódico por vía telefónica y debates didácticos y abiertos en grupos pequeños. En ese sentido, la intervención deberá consistir en una educación didáctica, preparación para resolver problemas y dudas, y planes de atención individualizados, considerando la participación también de la familia y/o cuidadores del paciente en la asesoría conductual.

BPC 3:
Se sugiere que las intervenciones sean impartidas por profesionales especialmente capacitados, incluidos dietistas o nutricionistas, fisioterapeutas o profesionales del ejercicio, educadores de salud o psicólogos.

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