Acute myocardial infarction: pre-hospital and in-hospital management. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.

The management of acute myocardial infarction has undergone major changes in recent years. Good practice can now be based on sound evidence derived from well-conducted clinical trials. Because of this, the European Society of Cardiology decided that it was opportune to provide guidelines and appointed a Task Force to formulate these. It must be recognised, however, that many aspects of treatment, such as the management of cardiac arrest and shock, depend upon experience rather than upon randomized controlled experiments. Furthermore, even when excellent clinical trials have been undertaken, their results are open to interpretation. Finally, treatment options may be limited by resources; cost-effectiveness is an important issue when deciding upon therapeutic strategies. In setting out these guidelines, the Task Force has attempted to define which treatment strategies are based on unequivocal evidence and which are open to genuine differences of opinion. As always with guidelines, they are not prescriptive. Patients vary so much from one another that individual care is paramount and there is still an important place for clinical judgment, experience and common sense.