Preamble
Introduction
- Definitions
- Universal definition of myocardial infarction
- Unstable angina in the era of high-sensitivity cardiac troponin assays
- Epidemiology
- What is new?
- Number and breakdown of classes of recommendations (Supplementary data)
Diagnosis
- Clinical presentation (Supplementary data)
- Physical examination (Supplementary data)
- Diagnostic tools
- Electrocardiogram
- Biomarkers: high-sensitivity cardiac troponin
- Rapid ‘rule-in’ and ‘rule-out’ algorithms
- Observe
- Non-invasive imaging
- Differential diagnosis
Risk assessment and outcomes
- Electrocardiogram indicators (Supplementary data)
- Biomarkers
- Clinical scores for risk assessment (Supplementary data)
- Bleeding risk assessment
- Integrating ischaemic and bleeding risks
Pharmacological treatments
- Antithrombotic treatment
- Antiplatelet drugs and pre-treatment
- Peri-interventional anticoagulant treatment
- Peri-interventional antiplatelet treatment
- Post-interventional and maintenance treatment
- Pharmacological treatment of ischaemia (Supplementary data)
- Supportive pharmacological treatment (Supplementary data)
- Nitrates and beta-blockers (Supplementary data)
- Managing oral antiplatelet agents in patients requiring long-term oral anticoagulants
- Patients with atrial fibrillation without mechanical prosthetic heart valves or moderate-to-severe mitral stenosis undergoing percutaneous coronary intervention or managed (Supplementary data)
- Patients requiring vitamin K antagonists or undergoing coronary artery bypass surgery
- Management of acute bleeding events (Supplementary data)
- General supportive measures (Supplementary data)
- Bleeding events on antiplatelet agents (Supplementary data)
- Bleeding events on vitamin K antagonists (Supplementary data)
- Bleeding events on non-vitamin K antagonist oral anticoagulants (Supplementary data)
- Non-access-related bleeding events (Supplementary data)
- Bleeding events related to percutaneous coronary intervention (Supplementary data)
- Bleeding events related to coronary artery bypass surgery (Supplementary data) 68
- Transfusion therapy (Supplementary data)
- Recommendations for bleeding management and blood transfusion in non-ST-segment elevation acute coronary syndromes for anticoagulated patients
Invasive treatments
- Invasive coronary angiography and revascularization
- Routine invasive vs. selective invasive approach (Supplementary data)
- Timing of invasive strategy
- Pattern of coronary artery disease in non-ST-segment elevation acute coronary syndrome (Supplementary data)
- How to identify the culprit lesion? (Supplementary data)
- Spontaneous coronary artery dissection
- Fractional flow reserve, instantaneous wave-free ratio, and other resting indices (Supplementary data)
- Intracoronary imaging
- Conservative treatment
- Patients who are not candidates for invasive coronary angiography
- Patients with coronary artery disease not amenable to revascularization
- Technical aspects
- Technical aspects and challenges
- Vascular access
- Revascularization strategies
- Coronary artery bypass grafting
- Percutaneous coronary intervention vs. coronary artery bypass surgery
- Specific situations
- Management of patients with ongoing myocardial ischaemia
- Management of patients with cardiac arrest
- Recommendations for coronary revascularization
Myocardial infarction with non-obstructive coronary arteries and alternative diagnoses
Special populations
- Heart failure and cardiogenic shock
- Diabetes mellitus
- Chronic kidney disease
- Anaemia
- Thrombocytopenia (Supplementary data)
- Thrombocytopenia related to glycoprotein IIb/IIIa inhibitors (Supplementary data)
- Heparin-induced thrombocytopenia (Supplementary data)
- The older person
- Frailty
- Sex disparities
Long-term management of non-ST-segment elevation acute coronary syndrome (Supplementary data)
- Lifestyle management (Supplementary data)
- Smoking (Supplementary data)
- Diet and alcohol (Supplementary data)
- Weight management (Supplementary data)
- Physical activity (Supplementary data)
- Cardiac rehabilitation (Supplementary data)
- Psychosocial factors (Supplementary data)
- Environmental factors (Supplementary data)
- Sexual activity (Supplementary data)
- Adherence and sustainability (Supplementary data)
- Influenza vaccination (Supplementary data)
- Pharmacological management (Supplementary data)
- Anti-ischaemic drugs
- Antithrombotic treatments
- Proton pump inhibitors (Supplementary data)
- Statins and other lipid-lowering agents
- Glucose-lowering therapy in patients with diabetes
- Renin-angiotensin-aldosterone system blockers (Supplementary data)
- Mineralocorticoid receptor antagonist therapy (Supplementary data)
- Antihypertensive therapy (Supplementary data)
- Hormone replacement therapy (Supplementary data)
Quality measures
Management strategy
Key messages
Gaps in evidence for non-ST-segment elevation acute coronary syndrome care and future research
To do and not to do
Supplementary data
Appendix
References