The National Institute for Health and Care Excellence has published a draft updated guideline on acute coronary syndromes to improve survival and quality of life for people who have a heart attack or unstable angina.
It brings together recommendations from existing guidelines and partially updates:
- Unstable angina and NSTEMI: early management (CG94).
- Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172).
- Myocardial infarction with ST-segment elevation: acute management (CG167).
- Hyperglycaemia in acute coronary syndromes: management (CG130).
It also covers risk assessment, drug treatment, invasive management, cardiac rehabilitation and planning for discharge.
The new recommendations include:
- Offering prasugrel or ticagrelor (rather than clopidogrel as currently recommended by NICE) as part of dual anti-platelet therapy with aspirin for people with unstable angina and NSTEMI having coronary angiography.
- Offering prasugrel as part of dual antiplatelet therapy with aspirin to people with acute STEMI intended for treatment with PCI (rather than the more commonly used ticagrelor or clopidogrel).
- Considering coronary angiography (with follow-on PCI if indicated) within 72 hours of first admission (rather than 96 hours NICE currently recommends) for people with unstable angina and NSTEMI who have an intermediate or higher risk of future adverse cardiovascular events.
- Offering a drug-eluting stent to people with unstable angina, NSTEMI and acute STEMI undergoing revascularisation by PCI.
- Offering complete revascularisation with PCI for people with acute STEMI and multivessel coronary artery disease without cardiogenic shock, either at the time of primary PCI or later during the same admission. For people with cardiogenic shock it recommends culprit vessel only revascularisation.
The guideline is open for consultation until Friday 27 March 2020 at 5pm and is expected to be published on 30 July.