This guideline covers the early and longer-term (rehabilitation) management of acute coronary syndromes. These include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The guideline aims to improve survival and quality of life for people who have a heart attack or unstable angina.

See the visual summaries on STEMI, unstable angina NSTEMI, and secondary prevention.
View visual summary
View visual summary
View visual summary

This guideline does not cover management of spontaneous coronary artery dissection.

 The recommendations in this guideline were developed before the COVID-19 pandemic. Acute coronary syndromes are a possible sign of acute myocardial injury in patients with COVID-19. See recommendations on acute myocardial injury in our rapid guideline on managing COVID-19


This guideline includes new and updated recommendations on:

These supplement the existing recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • Adults with acute coronary syndromes, their families and carers

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces:

  • NICE guideline CG172 (published November 2013)
  • NICE guideline CG167 (published July 2013)
  • NICE technology appraisal guidance 230 (published July 2011)
  • NICE guideline CG94 (published March 2010)

It incorporates unchanged NICE guideline CG130 (published October 2011).

It updates NICE technology appraisal guidance on drug-eluting stents for the treatment of coronary artery disease (TA152) and guidance on the use of coronary artery stents (TA71).

It also updates and replaces NICE medical technologies guidance MTG1 (published December 2010). 

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)