Acute coronary syndrome (ACS) is a common diagnosis in preclinical emergency medicine. The term summarizes the acute manifestations of coronary artery disease. It ranges from unstable angina pectoris via cardiogenic shock to sudden cardiac death. The leading key symptom is chest pain. With this trigger symptom, a clinical diagnostic algorithm is initiated, acting quickly on the suspected diagnosis of acute myocardial infarction. Due to the potentially life-threatening course, rapid diagnosis and initiation of therapeutic measures is crucial. Pre-clinical antithrombotic medication and therapy for accompanying symptoms are paramount. As part of the initial assessment, important differential diagnoses should be considered and, within the first 10 minutes after medical contact, an ECG diagnosis should differentiate between ACS with and without ST segment elevations. If ACS is diagnosed, acetylsalicylic acid should be given to inhibit platelet aggregation. The benefits outweigh the very low risk of unnecessary administration. Patients with ACS should be taken to hospital immediately for coronary interventions (PCI). In the case of an ACS with ST segment elevations, reperfusion therapy should be carried out within 120 minutes. In the case of an ACS without ST segment elevations, the time limit (2 - 72 h) until reperfusion is based on the risk stratification. In the majority of cases, the coronary stenosis causing the infarction can be treated with PCI. However, invasive diagnostics show no significant stenosis in a significant proportion of patients with myocardial infarction (prevalence 1 - 14%). This is known as "myocardial infarction with non-obstructive coronary arteries" (MINOCA) and further differential diagnosis should be initiated in these patients.
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