Acute Coronary Syndrome: Reperfusion & Antithrombotics — free guideline decision tool

This tool gives the reperfusion or intervention timing and the antiplatelet/anticoagulation strategy for acute coronary syndrome, separating STEMI from NSTE-ACS.

STEMI: primary PCI if feasible ≤ 120 min, else thrombolysis within 12 h then transfer. NSTE-ACS: no thrombolysis, intervention by risk (very-high < 2 h, high < 24 h, intermediate < 72 h, low selective). DAPT (aspirin + ticagrelor) + parenteral anticoagulant ≥ 12 months.

Use to choose reperfusion in STEMI (primary PCI vs thrombolysis by time and feasibility) and intervention timing in NSTE-ACS by risk, with the antithrombotic backbone.

NSTE-ACS is never thrombolysed; the decision is intervention timing by risk, whereas STEMI hinges on the earliest reperfusion. (original synthesis · not guideline verbatim) Ticagrelor is the preferred P2Y12 agent; prasugrel is limited to known coronary anatomy planned for PCI. Add β-blocker, statin, and ACEi/ARB unless contraindicated, and assess bleeding risk (CRUSADE).

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: ACS type STEMI (ST-elevation), Primary PCI feasible within 120 min (for STEMI) Yes, Time from onset (for STEMI) ≤ 12 h, NSTE-ACS risk stratification Very high risk → Result: Strategy STEMI: reperfuse as early as possible（Reperfusion: Primary PCI (preferred; FMC-to-wire-crossing ≤ 90–120 min where possible), Antiplatelet: Aspirin loading 300 mg → 75–100 mg/d + P2Y12 (ticagrelor 180 mg preferred, or clopidogrel 600 mg), DAPT for at least 12 months, Anticoagulation: Parenteral anticoagulation: unfractionated heparin or bivalirudin for primary PCI (bivalirudin favored with high bleeding risk); enoxaparin/UFH for thrombolysis） Inputs: ACS type NSTE-ACS (NSTEMI/unstable angina), Primary PCI feasible within 120 min (for STEMI) No, Time from onset (for STEMI) > 24 h, NSTE-ACS risk stratification Low risk → Result: Strategy NSTE-ACS: risk stratification defines intervention（Intervention timing: No thrombolysis; by risk stratification: Selective intervention or non-invasive evaluation first, Antiplatelet: Aspirin loading 300 mg → 75–100 mg/d + P2Y12 (ticagrelor preferred; prasugrel limited to known coronary anatomy planned for PCI), DAPT for at least 12 months, Anticoagulation: Parenteral anticoagulation: fondaparinux preferred for conservative treatment; UFH or enoxaparin for planned intervention）