Introduction

Introduction

This guideline updates and replaces recommendations for the early management of unstable angina and NSTEMI from NICE technology appraisal guidance 47 and 80.

Recommendation 1.3.6 has been replaced by recommendation 1.3.18 in MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction.

Recommendation 1.5.11 has been updated to take into account people with a learning disability.

See Changes after publication for details.

The term 'acute coronary syndromes' encompasses a range of conditions from unstable angina to ST-segment-elevation myocardial infarction (STEMI), arising from thrombus formation on an atheromatous plaque. This guideline addresses the early management of unstable angina and non-ST-segment-elevation myocardial infarction (NSTEMI) once a firm diagnosis has been made and before discharge from hospital. If untreated, the prognosis is poor and mortality high, particularly in people who have had myocardial damage. Appropriate triage, risk assessment and timely use of acute pharmacological or invasive interventions are critical for the prevention of future adverse cardiovascular events (myocardial infarction, stroke, repeat revascularisation or death). The guideline does not cover the management of STEMI or specific complications of unstable angina and NSTEMI such as cardiac arrest or acute heart failure. Assessment and classification of people presenting with undifferentiated chest pain are covered in 'Chest pain of recent onset' (NICE clinical guideline 95)[1].

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. Unlicensed or off-label use is indicated by a footnote.

Throughout the guideline, the term 'angiography' refers to invasive angiography.

Recommendations 1.3.4 to 1.3.8 update and replace recommendations for the early management of unstable angina and NSTEMI from 'Clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome', NICE technology appraisal guidance 80 (TA 80)

Recommendations 1.3.9 to 1.3.11 update and replace recommendations for the early management of unstable angina and NSTEMI from 'Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndrome', NICE technology appraisal guidance 47 (TA 47).



[1] More information on 'Chest pain of recent onset' (NICE clinical guideline 95) is available.

  • National Institute for Health and Care Excellence (NICE)