The new European Society of Cardiology acute coronary syndrome guideline and its impact in the CPU and emergency department setting

The new ESC acute coronary syndrome guideline and its impact in the CPU and emergency department setting Herz. 2024 Jun;49(3):185-189. doi: 10.1007/s00059-024-05241-6   The new guideline on acute coronary syndrome (ACS) of the European Society of Cardiology (ESC) replaces two separate guidelines on ST-elevation myocardial infarction (STEMI) and non-ST-elevation (NSTE) ACS . This change of paradigm reflects the experts view that the acute coronary syndrome is a continuum,starting with unstable angina and ending in cardiogenic shock or cardiac arrest due to severe myocardial ischemia. Secondary, partly non-atherosclerotic-caused myocardial infarctions ("type 2") are not integrated in this concept. With respect to acute care in the setting of emergency medicine and the chest pain unit structures, the following new aspects have to be taken into account: 1. New procedural approach as "think acute coronary syndrome" meaning "abnormal ECG," "clinical context," and "stable patient" 2. New recommendation regarding a holistic approach for frail patients 3. Revised recommendations regarding imaging and timing of invasive strategy in suspected non-ST elevation acute coronary syndrome. 4- Revised recommendations for antiplatelet and anticoagulant therapy in ST-elevation myocardial infarction 5. Revised recommendations for cardiac arrest and out-of-hospital cardiac arrest 6. Revised recommendations for in-hospital management (starting in the CPU/ED ) and acute coronary syndrome comorbid conditions. In summary, the changes are mostly gradual and are not based on extensive new evidence, but more on focused and healthcare process-related considerations. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.