The levels of evidence [A-D] supporting the recommendations are defined at the end of the "Major Recommendations" field.


  • If a person at risk of a myocardial infarction (MI) has an acute coronary syndrome lasting over 20 minutes, imminent MI must be suspected. Instead of chest pain, acute dyspnoea may be the primary symptom.
  • An acute coronary syndrome without myocardial damage is often unstable angina, which calls for active treatment.
  • The diagnosis should be made without delay since early therapy improves the prognosis decisively.
  • Thrombolytic therapy is given as early as possible in all cases with a clinical picture of imminent MI and corresponding electrocardiogram (ECG) changes. See the Finnish Medical Society Duodecim guideline "Thrombolytic Therapy in Acute Myocardial Infarction."
  • Acute angioplasty (percutaneous transluminal coronary angioplasty [PTCA], percutaneous coronary intervention [PCI]) is an alternative or a complementary procedure to thrombolytic therapy (Grines et al., 2003; DARE-20030287, 2004; Keeley, Boura, & Grines, 2003; DARE-20038039, 2004) [A]. Angioplasty is probably preferred, at least in ST elevation MI (Keeley, Boura, & Grines, 2003).
  • If there are no contraindications, aspirin and a beta-blocker should be started for all patients and, for most patients, also an angiotensin-converting enzyme (ACE) inhibitor and a statin on the first days of treatment.
  • Health care system should include a planned care pathway for coronary patients.