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. NICE has produced a COVID-19 rapid guideline on acute myocardial injury.
This guideline includes new and updated recommendations on:
- dual antiplatelet therapy and antithrombin therapy for primary percutaneous coronary intervention (PCI) for acute STEMI
- complete revascularisation versus culprit vessel-only PCI for STEMI
- drug-eluting stents for acute STEMI
- dual antiplatelet therapy for STEMI not treated with PCI
- initial drug therapy for unstable angina and NSTEMI
- coronary angiography with follow-on PCI for unstable angina and NSTEMI
- managing unstable angina and NSTEMI not treated with PCI
- combination antiplatelet and anticoagulant treatment as secondary prevention for people with a separate indication for anticoagulation
- duration 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 STEMI
- the early management of unstable angina and NSTEMI
- MI: secondary prevention and rehabilitation
Who is it for?
- Healthcare professionals
- Commissioners and providers
- Adults with acute coronary syndromes, their families and carers