title: Management of Patients With NSTE-ACS: A Comparison of the Recent AHA/ACC and ESC Guidelines.
abstract: Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the management of NSTE-ACS, most recently in in 2014 and 2015, respectively. The present review compares and contrasts the 2 guidelines, with a focus on the strength of recommendation and level of evidence in the approach to initial presentation and diagnosis of NSTE-ACS, risk assessment, treatments, and systems of care. Important differences include the use of a rapid rule-out protocol with high-sensitivity troponin assays, a preference for prasugrel/ticagrelor and fondaparinux for anticoagulation therapy, and a preference for radial arterial access in the European Society of Cardiology guidelines compared with the American Heart Association/American College of Cardiology guidelines. We also highlight the similarities and differences in the guidelines for special patient populations and suggest areas of further study.
authors.affiliation: Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California. Electronic address: kenneth.mahaffey@stanford.edu.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D002309:Cardiology / Q000379:methods*; D004562:Electrocardiography; D005060:Europe; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D014481:United States
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: acute coronary syndrome; anticoagulants; antiplatelet; quality of care; risk assessment