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

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