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Non-ST Elevation Acute Coronary Syndromes
1. Preamble 2. Introduction 2.1 Definitions and pathophysiology2.1.1 Universal definition of myocardial infarction 220.127.116.11 Type 1 MI18.104.22.168 Type 2 MI 2.1.2 Unstable angina in the era of high-sensitivity cardiac troponin assays 2.1.3 Pathophysiology and epidemiology3. Diagnosis 3.1 Clinical presentation3.2 Physical examination 3.3 Diagnostic tools 3.3.1 Electrocardiogram 3.3.2 Biomarkers3.3.3 ‘Rule-in’ and ‘rule-out’ algorithms 3.3.4 Non-invasive imaging3.4 Differential diagnosis 4. Risk assessment and outcomes4.1 Clinical presentation, electrocardiogram and biomarkers 4.1.1 Clinical presentation 4.1.2 Electrocardiogram 4.1.3 Biomarkers 4.2 Ischaemic risk assessment 4.2.1 Acute risk assessment4.2.2 Cardiac rhythm monitoring 4.2.3 Long-term risk 4.3 Bleeding risk assessment4.4 Recommendations for diagnosis, risk stratification, imagingand rhythm monitoring in patients with suspected non-ST elevationacute coronary syndromes 5. Treatment 5.1 Pharmacologic treatment of ischaemia 5.1.1 General supportive measures 5.1.2 Nitrates 5.1.3 Beta-blockers 5.1.4 Other drug classes (see Web addenda)5.1.5 Recommendations for anti-ischaemic drugs inthe acute phase of non-ST-elevation acute coronary syndromes 5.2 Platelet inhibition 5.2.1 Aspirin 5.2.2 P2Y12 inhibitors5.2.3 Timing of P2Y12 inhibitor administration 5.2.4 Monitoring of P2Y12 inhibitors5.2.5 Premature discontinuation of oral antiplatelet therapy 5.2.6 Duration of dual antiplatelet therapy 5.2.7 Glycoprotein IIb/IIIa inhibitors 5.2.8 Vorapaxar 5.2.9 Recommendations for platelet inhibition in non-ST-elevation acute coronary syndromes 5.3 Anticoagulation 5.3.1 Anticoagulation during the acute phase5.3.2 Anticoagulation following the acute phase 5.3.3 Recommendations for anticoagulation in non-ST-elevation acute coronary syndromes 5.4 Managing oral antiplatelet agents in patients requiring long-term oral anticoagulants 5.4.1 Patients undergoing percutaneous coronary intervention 5.4.2 Patients medically managed or requiring coronary artery bypass surgery 5.4.3 Recommendations for combining antiplatelet agentsand anticoagulants in non-ST-elevation acute coronarysyndrome patients requiring chronic oral anticoagulation 5.5 Management of acute bleeding events5.5.1 General supportive measures 5.5.2 Bleeding events on antiplatelet agents5.5.3 Bleeding events on vitamin K antagonists5.5.4 Bleeding events on non-vitamin K oral anticoagulants5.5.5 Non-access-related bleeding events5.5.6 Bleeding events related to percutaneous coronary intervention 5.5.7 Bleeding events related to coronary artery bypass surgery5.5.8 Transfusion therapy 5.5.9 Recommendations for bleeding management and blood transfusion in non-ST-elevation acute coronary syndromes 5.6 Invasive coronary angiography and revascularization 5.6.1 Invasive coronary angiography 5.6.2 Routine invasive vs. selective invasive approach 5.6.3 Timing of invasive strategy 5.6.4 Conservative treatment 5.6.5 Percutaneous coronary intervention 5.6.6 Coronary artery bypass surgery 5.6.7 Percutaneous coronary intervention vs. coronary artery bypass surgery 5.6.8 Management of patients with cardiogenic shock 5.6.9 Recommendations for invasive coronary angiographyand revascularization in non-ST-elevation acute coronary syndromes5.7 Gender specificities 5.8 Special populations and conditions 5.8.1 The elderly and frail patients 5.8.2 Diabetes mellitus5.8.3 Chronic kidney disease 5.8.4 Left ventricular dysfunction and heart failure 5.8.5 Atrial fibrillation 5.8.6 Anaemia5.8.7 Thrombocytopenia 5.8.8 Patients requiring chronic analgesic or anti-inflammatory treatment 5.8.9 Non-cardiac surgery 5.9 Long-term management 5.9.1 Medical therapy for secondary prevention 5.9.2 Lifestyle changes and cardiac rehabilitation 5.9.3 Recommendations for long-term management after non-ST-elevation acute coronary syndromes 6. Performance measures7. do and not to do messages from the guidelines
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