Windecker Stephan, Hernández-Antolín Rosa-Ana, Stefanini Giulio G, Wijns William, Zamorano Jose L
Bern University Hospital, Bern, Switzerland.
EuroIntervention. 2014 Aug;10 Suppl T:T23-31. doi: 10.4244/EIJV10STA5.
To highlight differences between the most recent guidelines of the European Society of Cardiology (ESC) and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) on the management of ST-elevation myocardial infarction (STEMI).
ESC 2012 and ACCF/AHA 2013 guidelines on the management of STEMI were systematically reviewed for consistency. Recommendations were matched, directly compared in terms of class of recommendation and level of evidence, and classified as "identical", "overlapping", or "different". Out of 32 recommendations compared, 26 recommendations (81%) were classified as identical or overlapping, and six recommendations (19%) were classified as different. Most diverging recommendations were related to minor differences in class of recommendation between the two documents. This applies to recommendations for reperfusion therapy >12 hours after symptom onset, immediate transfer of all patients after fibrinolytic therapy, rescue PCI for patients with failed fibrinolysis, and intra-aortic balloon pump use in patients with cardiogenic shock. More substantial differences were observed with respect to the type of P2Y12 inhibitor and duration of dual antiplatelet therapy.
The majority of recommendations for the management of STEMI according to ESC and ACCF/AHA guidelines were identical or overlapping. Differences were explained by gaps in available evidence, in which case expert consensus differed between European and American guidelines due to divergence in interpretation, perception, and culture of medical practice. Systematic comparisons of European and American guidelines are valuable and indicate that interpretation of available evidence leads to agreement in the vast majority of topics. The latter is indirect support for the process of review and guideline preparation on both sides of the Atlantic.
强调欧洲心脏病学会（ESC）和美国心脏病学会基金会/美国心脏协会（ACCF/AHA）关于ST段抬高型心肌梗死（STEMI）管理的最新指南之间的差异。
对ESC 2012年和ACCF/AHA 2013年关于STEMI管理的指南进行系统回顾以确保一致性。将推荐意见进行匹配，直接根据推荐类别和证据水平进行比较，并分类为“相同”、“重叠”或“不同”。在比较的32条推荐意见中，26条推荐意见（81%）被分类为相同或重叠，6条推荐意见（19%）被分类为不同。大多数存在分歧的推荐意见与两份文件在推荐类别上的细微差异有关。这适用于症状发作超过12小时后的再灌注治疗、所有患者在溶栓治疗后立即转运、溶栓失败患者的补救性经皮冠状动脉介入治疗（PCI）以及心源性休克患者使用主动脉内球囊泵的推荐意见。在P2Y12抑制剂类型和双联抗血小板治疗持续时间方面观察到了更显著的差异。
根据ESC和ACCF/AHA指南，关于STEMI管理的大多数推荐意见相同或重叠。差异是由现有证据的差距所解释的，在这种情况下，由于欧洲和美国在医学实践的解释、认知和文化方面存在差异，专家共识也有所不同。欧美指南的系统比较很有价值，表明对现有证据的解释在绝大多数主题上达成了一致。这间接支持了大西洋两岸的审查和指南制定过程。
