Acute coronary syndromes: summary of updated NICE guidance

Acute coronary syndromes (ACS), comprising ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina, are an important cause of morbidity and mortality in the UK and worldwide.

What you need to know

  • Prasugrel is recommended as dual anti-platelet therapy in combination with aspirin for people with ST-elevation myocardial infarction being treated with primary percutaneous coronary intervention (PCI)

  • Prasugrel or ticagrelor are recommended as dual anti-platelet therapy in combination with aspirin for people with non-ST-elevation myocardial infarction or unstable angina being treated with PCI

  • In people with acute coronary syndromes treated with PCI, who have a separate indication for oral anticoagulation (eg, atrial fibrillation), use clopidogrel and oral anticoagulant for up to one year. Do not use prasugrel or ticagrelor, and avoid long-term addition of aspirin

Clinical areas updated in the NICE guideline on acute coronary syndromes

  • Early invasive management in unstable angina/NSTEMI

  • Anti-platelet therapy in adults with ACS

  • Anti-thrombin therapy in adults with unstable angina/NSTEMI who are being considered for coronary angiography within 24 hours of admission

  • Anti-thrombin therapy in adults with STEMI intended for primary PCI

  • Culprit vessel-only versus complete revascularisation in adults with STEMI undergoing primary PCI

  • Drug-eluting stents in adults with ACS

  • Anti-platelet and anticoagulant therapies for people who have had an ACS and a separate indication for anticoagulation

  • Duration of β-blocker therapy after myocardial infarction in adults without left ventricular dysfunction

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