Guidelines in review: Comparison of the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Abstract

In this Guidelines in Review, we review side-by-side the recommendations provided by the 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. We review the recommendations for imaging in the evaluation of patients with possible ACS followed by the diagnostic evaluation of patients with proven NSTE-ACS, based on their risk for adverse clinical events.

Bridging the Atlantic gap in clinical guidelines for non-ST-elevation acute coronary syndromes

“…Thus, we must be thankful to Prejean et al for providing us in this issue of the Journal a detailed comparative analysis summarizing agreements between such guidelines while highlighting important discrepancies. 3 As in guidelines on stable coronary artery disease (CAD), even in NSTEACS guidelines the clinical condition is the starting point which represents, in this case well, a potential complication in the natural history of CAD.…”

“…4 In patients with NSTEACS the management approach is of course altogether different, but discrepancies are evident also on the diagnostic approach. [1][2][3] Indeed, in NSTEACS, at odds with stable CAD, pre-test probability of CAD receives much lesser emphasis. The first issue rests on goals of tests and key limitations of test results.…”

“…Imaging is not indicated in patients at high or very high risk (for whom it is necessary, respectively, an early or an immediate invasive strategy), with the exception of echocardiography to exclude mechanical complications according to European guidelines. [1][2][3] Instead, imaging is crucial in particular for low-risk patients in whom a selective invasive strategy is envisioned. Imaging may also be beneficial in those subjects who undergo revascularization within 72 hours from symptom onset but not acutely.…”

Comparison of the AHA/ACC vs ESC guidelines for management of patients with non-ST-elevation acute coronary syndromes: Are the differences clinically different?

“…1 compare the 2014 American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for the management of patients with non-ST-elevation acute coronary syndromes (ACS) 2 and the 2015 European Society of Cardiology (ESC) guidelines for the management of ACS in patients without persistent STsegment elevation. 3 This review focuses on the role of noninvasive testing in the management of these patients, the application of invasive vs conservative treatment strategies, and the evaluation and treatment of specific patient subsets.…”

“…Prejean et al 1 have developed a useful document that facilitates comparison of the ACC/AHA and ESC guidelines addressing non-ST-segment elevation ACS. Overall, there is significant similarity between the guidelines for ratings recommendations for the majority of the clinical scenarios addressed.…”