[ESC guidelines 2020: acute coronary syndrome without persistent ST-segment elevation : What is new?]

Area of Science:

• Cardiology
• Clinical Practice Guidelines

Background:

• The European Society of Cardiology (ESC) released updated guidelines for managing acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) in August 2020.
• These guidelines supersede the 2015 recommendations, incorporating significant changes in clinical practice.

Purpose of the Study:

• To outline the key updates and changes in the 2020 ESC NSTE-ACS guidelines.
• To highlight advancements in diagnostic work-up, risk stratification, and treatment strategies for NSTE-ACS.

Main Methods:

• Review and synthesis of the 2020 ESC NSTE-ACS guidelines.
• Focus on changes in diagnostic protocols, including the use of highly sensitive cardiac troponin (hs-cTn) assays.
• Analysis of updated recommendations for risk stratification, antithrombotic therapy, and coronary angiography timing.

Main Results:

• Emphasis on rapid triage using hs-cTn assays for early rule-in or rule-out of NSTE-ACS.
• Introduction of new sections on spontaneous coronary artery dissection (SCAD) and myocardial infarction with nonobstructive coronary arteries (MINOCA).
• Revised risk stratification removing the intermediate-risk group and emphasizing similar treatment for low-risk patients as chronic coronary syndrome.

Conclusions:

• The updated guidelines promote earlier and more precise diagnosis of NSTE-ACS.
• Individualized treatment approaches, particularly in antiplatelet therapy, are recommended based on patient-specific risks.
• The guidelines introduce novel aspects for managing specific NSTE-ACS populations and quality indicators for treatment.