Guideline updates: Goodbye NSTEMI, hello NSTE-ACS
New terms like non-ST-elevation acute coronary syndrome (NSTE-ACS) and a continuum view of unstable angina are a large part of the updated joint guidelines published Sept. 23 in Circulation.
The American College of Cardiology and the American Heart Association came together with the intention of updating both guidelines and the way clinicians look at this disease pathology. This extensive document was written by the committee chaired by Ezra A. Amsterdam, MD, of the University of California, Davis Medical Center in Sacramento.
“There have been tremendous advances in the diagnosis and management of NSTE-ACS since the last guideline,” stated Amsterdam in a press release. “We attempted to improve the utility of the guidelines with a focused method that eliminated repetition of ancillary information.”
The guidelines still cover a lot of ground. In addition to replacing some terms like non-ST elevated myocardial infarction (NSTEMI) with NSTE-ACS and the term “ischemia-guided strategy” with “initial conservative management,” the guideline went on to describe newer treatment options and outline reasonable practices.
Several recommendations regarding biomarkers and diagnosis remain familiar, but instead describe a continuum-spectrum type approach to unstable angina in its many forms.
High-, medium-, and low-risk patients were considered as part of the document’s scope. Risk stratification was underscored as being of particular importance and is expanded from earlier guidelines.
One particular item of note included a recommendation for diagnosis and treatment of low-risk patients, an aspect that had not been previously endorsed. The committee noted that advances in noninvasive testing may help to distinguish patients early and allow for an approach to therapy that would improve long-term outcomes before the disease progressed.
New treatments, symptom education, discharge recommendations, cholesterol management, medication and other therapies were also discussed at length. They provided tables and algorithms to assist physicians in diagnosis and decision making.
However, Amsterdam et al reminded readers that guidelines and recommendation should not replace a clinician’s judgment based on patient presentation and they should not be considered a catch-all when treating ischemic patients.