[Acute coronary syndrome without ST-elevation (NSTE-ACS)].

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Acute coronary syndrome without ST-elevation (NSTE-ACS) requires timely risk stratification for optimal diagnosis and treatment.
• Clinical symptoms, ECG findings, and troponin levels are critical for assessing NSTE-ACS patients.

Purpose of the Study:

• To outline the diagnostic and treatment strategies for NSTE-ACS based on patient risk profiles.
• To emphasize the role of high-sensitivity troponin assays in the rapid diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI).

Main Methods:

• Utilizing 0/3-hour or 0/1-hour algorithms with high-sensitivity troponin assays for rapid NSTEMI rule-in or rule-out.
• Initiating dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor antagonist in the acute phase.
• Adjusting DAPT duration based on individual patient risk for bleeding or ischemia.

Main Results:

• High-sensitivity troponin enables efficient diagnosis of NSTEMI, but troponin-negative results do not exclude unstable angina pectoris.
• DAPT is recommended for 12 months post-acute phase, regardless of treatment strategy (PCI, bypass surgery, conservative).
• DAPT duration can be shortened to 6 months for high bleeding risk or extended up to 36 months for high ischemic risk.

Conclusions:

• Risk stratification is key in NSTE-ACS management, guiding invasive strategies and treatment duration.
• Troponin testing is pivotal for diagnosing NSTEMI, while other clinical factors are essential for unstable angina.
• Tailoring DAPT duration based on bleeding and ischemic risk optimizes patient outcomes in NSTE-ACS.