Practice Guidelines

Early management of unstable angina and non-ST segment elevation myocardial infarction: summary of NICE guidance

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1134 (Published 24 March 2010) Cite this as: BMJ 2010;340:c1134
  1. Emily Crowe, senior research fellow 1,
  2. Kate Lovibond, senior health economist1,
  3. Huon Gray, consultant cardiologist 2,
  4. Robert Henderson, consultant cardiologist 3,
  5. Taryn Krause, senior project manager1,
  6. John Camm, professor of clinical cardiology 4
  7. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE
  2. 2Southampton University Hospital, Southampton SO16 6YD
  3. 3Nottingham University Hospitals, Nottingham NG5 1PB
  4. 4St George’s, University of London, London SW17 0RE
  1. Correspondence to: H Gray huon{at}cardiology.co.uk

    Why read this summary?

    Acute coronary syndromes are a common cause of morbidity and mortality, and they place a major burden on healthcare providers in both industrialised and developing countries. A range of drug treatments and invasive management strategies is available, but the potential to reduce ischaemic risk must be balanced against the increased risk of bleeding complications. This article summarises recommendations made in the National Institute for Health and Clinical Excellence (NICE) guideline for the management of unstable angina and non-ST elevation myocardial infarction, including risk assessment, drug treatment, invasive management, cardiac rehabilitation, and planning of discharge.1 Patients with acute coronary syndrome who do not have persistent ST segment elevation on their electrocardiogram (ECG) at presentation are classified as having non-ST elevation myocardial infarction if the serum troponin concentration is raised and as having unstable angina if it is normal.

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the experience and opinion of the Guideline Development Group (GDG) on what constitutes good practice.

    Risk assessment

    As soon as the diagnosis is made, formally assess the risk of future adverse cardiovascular events using an established risk scoring system (for example, global registry of acute cardiac events.2 [Based on observational study and registry database evidence]

    Include in the formal risk assessment:

    • A full clinical history (including age, previous myocardial infarction, and previous percutaneous coronary intervention or coronary artery bypass grafting)

    • A physical examination (including measurement of blood pressure and heart rate)

    • A resting 12 lead ECG (looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia)

    • Blood tests (including concentrations of troponin I or troponin T, creatinine, glucose, and haemoglobin).

    [All based on registry database evidence and the experience and opinion of the …

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