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Author: Admin | 2025-04-28
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.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. Last reviewed: 19 December 2024We added links to relevant technology appraisal guidance in the sections on dual antiplatelet therapy, coronary angiography with follow-on PCI, drug therapy for secondary prevention and people with reduced left ventricular ejection fraction. This is to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice.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). Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.See the visual summaries on STEMI, unstable angina NSTEMI, and secondary prevention.RecommendationsThis guideline includes new and updated recommendations on:dual antiplatelet therapy and antithrombin therapy for primary percutaneous coronary intervention (PCI) for acute STEMIcomplete revascularisation versus culprit vessel-only PCI for STEMI drug-eluting stents for acute STEMI dual antiplatelet therapy for STEMI not treated with PCIinitial drug therapy for unstable angina and NSTEMIcoronary angiography with follow-on PCI for unstable angina and NSTEMImanaging unstable angina and NSTEMI not treated with PCIcombination antiplatelet and anticoagulant treatment as secondary prevention for people with a separate indication for anticoagulationduration of beta-blocker treatment for people with reduced left ventricular ejection fraction after myocardial infarction (MI)These supplement the existing recommendations on:the early management of STEMIthe early management of unstable angina and NSTEMIMI: secondary prevention and rehabilitationWho is it for?Healthcare professionalsCommissioners and providersAdults with acute coronary syndromes, their families and carersGuideline development processHow we develop NICE guidelinesYour responsibilityThe 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
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