This guideline covers treatments for people aged 18 and over with unstable angina (recurring chest pain) or a type of heart attack called non-ST-segment-elevation myocardial infarction (NSTEMI). It aims to ensure that people get treatment quickly. It recommends that as soon as NSTEMI or unstable angina is diagnosed, healthcare professionals assess people for risk of more serious heart problems in the future to guide their treatment.  

In November 2013, recommendation 1.3.6 was changed in line with recommendations in NICE’s guideline on myocardial infarction. Recommendation 1.5.11 was updated to take into account people with a learning disability.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • People with NSTEMI or unstable angina and their carers

Is this guideline up to date?

NICE's guidelines on unstable angina and NSTEMI: early management (CG94), myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172) and myocardial infarction with ST-segment elevation: acute management (CG167) are being combined and updated. The new guideline will be titled acute coronary syndromes when published.

Guideline development process

How we develop NICE guidelines

This guidance updates and replaces recommendations 1.2, 1.3, 1.4 and 1.6 in NICE technology appraisal 47 (September 2002) and recommendations 1.1 and 1.2 from NICE technology appraisal 80 (July 2004).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)