CardioExchange Archive

A new guideline released today by the American College of Cardiology and the American Heart Association reflects important changes in the last 7 years in the understanding of what is now known as non–ST-elevation acute coronary syndromes (NSTE-ACS).

The previous 2007 guideline used different terminology and referred to the same patient population as “unstable angina and non-ST-elevation myocardial infarction (NSTEMI)”. The new terminology “emphasizes the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations,” according to a joint press release from the AHA and ACC.

Although NSTE-ACS patients with significant coronary disease are generally eligible for an early invasive strategy, some low-risk patients may be eligible for medical therapy. “Guideline-directed medical therapy has not always been optimally utilized and advances in noninvasive testing have the potential to identify patients with NSTE-ACS at low-intermediate risk to distinguish candidates for invasive versus medical therapy,” says writing committee chair Ezra A. Amsterdam.

The new guideline also drops the term  “initial conservative management” in favor of “ischemia-guided strategy” in order “to more clearly convey the physiologic rationale of this approach.”

One major focus is the long-term treatment of patients following the acute phase, said the vice chair of the writing committee, Nanette Wenger. “The hospitalization period involves crisis management of ACS, which is pivotal to successful patient outcomes during the acute phase of disease. However, discharge planning in addition to patient and family education guide the long-term ambulatory care of the patient who has sustained a NSTE-ACS.”