Interventions for non-ST-segment elevation acute coronary syndromes

Summary

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a leading cause of morbidity and mortality in the western countries. The European Society of Cardiology has 2015 released new guidelines on the treatment of NSTE-ACS. These guidelines summarise the current evidence and its translation into clinical practice. Special attention has been given to diagnostic measures, risk stratification, and different therapeutic options. For the diagnostic work-up in the acute phase, the electrocardiogram (ECG) and the assessment of cardiac biomarkers play the central role. Most important changes relate to the introduction of a rapid new rule-out protocol by use of high- or ultrasensitive troponin assays and the choice of stent type. Furthermore, the diagnostic and therapeutic algorithm has been elaborated by recommendation of a general use of risk and bleeding scores and a diversified therapeutic regimen according to risk stratification. For all patients, administration of an anti-aggregatory therapy, including acetylsalicylic acid and prasugrel or ticagrelor, is indicated in the acute phase, while clopidogrel is only advised in the case of contraindications to either ticagrelor or prasugrel. In the chronic phase, optimal treatment of cardiovascular risk factors is of prime importance. However, in the last years some new data have been published including important...