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01-12-2021 | Ticagrelor | Evidence-Based Medicine, Clinical Trials and Their Interpretations (K. Nasir, Section Editor)

Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHA Guidelines on the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation

Authors: Mohammad Keykhaei, Haleh Ashraf, Sina Rashedi, Hossein Farrokhpour, Behnam Heidari, Shaghayegh Zokaei, Sayna Bagheri, Roham Foroumadi, Sara Asgarian, Aslan Amirian, Shahrokh Karbalai Saleh, Stefan James

Published in: Current Atherosclerosis Reports | Issue 12/2021

Abstract

Purpose of Review

We assessed the differences in the 2020 European Society of Cardiology (ESC) versus 2015 ESC and 2014 American College of Cardiology (ACC) guidelines on the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Recent Findings

The recent publication of the 2020 ESC has provided a comprehensive series of recommendations on diagnosis and management of patients presenting with NSTE-ACS. However, there are discrepancies between the 2020 ESC versus 2015 ESC and 2014 ACC guidelines, creating uncertainty among clinicians in routine practices. Our investigation provides insights into several domains, including diagnosis, risk stratification, pharmacological treatments, invasive treatment, and special populations.

Summary

Overall, it seems that the 2020 version of the ESC guideline for the management of NSTE-ACS provides the most evidence-based recommendations for clinicians; although due to the lack of validated investigation across some of the proposed recommendations, further longitudinal multicenter studies are warranted to address the current questions.

Graphical abstract

Diagnostic algorithm in NSTE-ACS. Abbreviations: ACC = American College of Cardiology; CABG = coronary artery bypass grafting; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CS = cardiogenic shock; ECG = electrocardiography; eGFR = estimated glomerular filtration rate; ESC = European Society of Cardiology; GRACE = Global Registry of Acute Coronary Events; HF = heart failure; LVEF = left ventricular ejection fraction; MPI = myocardial perfusion imaging; MR = mitral regurgitation; NSTE-ACS = non-ST-segment elevation acute coronary syndromes; PCI = percutaneous coronary intervention; TIMI = thrombolysis in myocardial infarction

Available only for authorised users

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Title: Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHA Guidelines on the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation
Authors: Mohammad Keykhaei
Haleh Ashraf
Sina Rashedi
Hossein Farrokhpour
Behnam Heidari
Shaghayegh Zokaei
Sayna Bagheri
Roham Foroumadi
Sara Asgarian
Aslan Amirian
Shahrokh Karbalai Saleh
Stefan James
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Ticagrelor
Cardiogenic Shock
ST-Segment Elevation Myocardial Infarction
Cardiogenic Shock
Acute Coronary Syndrome
Unstable Angina
Prasugrel
Arterial Diseases
Published in: Current Atherosclerosis Reports / Issue 12/2021
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-021-00976-7

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Abstract

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Summary

Graphical abstract

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