Coronary Artery Disease

ACC/AHA Release New Guidelines

In an attempt to become more user-friendly, the American College of Cardiology and the American Heart Association have released updated guidelines on non-ST-elevation acute coronary syndrome (NSTE-ACS).

Note: NSTE-ACS is the new terminology to replace what was once referred to as “unstable angina and non-ST-elevation myocardial infarction,” a serious and common cardiac condition.
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RELATED CONTENT
Non-ST-Segment Elevation MI and Unstable Angina
ST-Segment Elevation Myocardial Infarction
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This update to the 2007 ACC/AHA Guideline or the Management of Patients with Unstable Angina and Non–ST-Elevation Myocardial Infarction (NSTEMI) comes in response to new research and understanding uncovered over the past 7 years.

Of note:

  • While the previous iteration suggested invasive therapy for patients with NSTE-ACS and significant coronary artery disease, the update stresses that medical therapy may benefit some low-risk patients. 
  • The guidelines underscore the importance of further research into the use of combined, potent antithrombotic and anticoagulation therapy in certain patient groups, application of new, high-sensitive troponins, and the selection of high-risk elderly patients and women for interventional therapy.
  • The guidelines contain expanded recommendations regarding discharge (eg, education about symptoms, risk modification, routine medication with dual antiplatelet therapy, cholesterol management, cardiac rehab referrals, and guideline-directed medical therapy).

“The new title emphasizes the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations,” according to researchers. 

The update also replaces the phrase initial conservative management with ischemia-guided strategy to better reflect what is actually involved in the process.

“There have been tremendous advances in the diagnosis and management of NSTE-ACS since the last guideline. We attempted to improve the utility of the guidelines with a focused method that eliminated repetition of ancillary information,” they wrote.

The complete guidelines are published in the September issue of Circulation.

—Michael Potts

References:

1. Amsterdam EA, Wenger NK, Brindis RG, et al. Task force on practice guidelines coronary syndromes: executive Summary. Circulation. 2014 Sep 23 [epub ahead of print]. doi: 10.1161/CIR.0000000000000133  

2. American Heart Association/American College of Cardiology. Guideline aims to improve outcomes of patients with NSTE-ACS [press release]. September 23, 2014. http://newsroom.heart.org/news/guideline-aims-to-improve-outcomes-of-patients-with-nste-acs. Accessed September 24, 2014.