7 Implementation and audit


All clinicians who treat people with an ACS should review their current policies and practice in line with the guidance set out in section 1.


Local guidelines or care pathways, particularly those on the management of patients with unstable angina or MI, should incorporate the guidance in section 1.


To measure compliance locally with the guidance, the following criteria could be used. Further details of suggestions for audit are presented in appendix D.


The following groups of patients receive an intravenous small-molecule GP IIb/IIIa inhibitor (eptifibatide or tirofiban) as part of their initial medical management (together with aspirin and unfractionated heparin):

  • patients with unstable angina who are at high risk of subsequent MI or death

  • patients with NSTEMI who are at high risk of subsequent MI or death.


Patients who are at high risk and for whom PCI is recommended but delayed beyond the initial medical management phase receive a GP IIb/IIIa inhibitor (abciximab) as an adjunct to PCI.


A GP IIb/IIIa inhibitor (abciximab) is considered as an adjunct to PCI for all patients with diabetes who are undergoing elective PCI or for those patients undergoing complex procedures.


A GP IIb/IIIa inhibitor is not used for patients who are undergoing procedurally uncomplicated, elective single-vessel PCI, unless unexpected immediate complications occur.


Local clinical audits on the care of patients with ACS also could include criteria on other aspects of care referred to in the National Service Framework for Coronary Heart Disease.