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Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHA Guidelines on the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (K. Nasir, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We assessed the differences in the 2020 European Society of Cardiology (ESC) versus 2015 ESC and 2014 American College of Cardiology (ACC) guidelines on the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Recent Findings

The recent publication of the 2020 ESC has provided a comprehensive series of recommendations on diagnosis and management of patients presenting with NSTE-ACS. However, there are discrepancies between the 2020 ESC versus 2015 ESC and 2014 ACC guidelines, creating uncertainty among clinicians in routine practices. Our investigation provides insights into several domains, including diagnosis, risk stratification, pharmacological treatments, invasive treatment, and special populations.

Summary

Overall, it seems that the 2020 version of the ESC guideline for the management of NSTE-ACS provides the most evidence-based recommendations for clinicians; although due to the lack of validated investigation across some of the proposed recommendations, further longitudinal multicenter studies are warranted to address the current questions.

Graphical abstract

Diagnostic algorithm in NSTE-ACS. Abbreviations: ACC = American College of Cardiology; CABG = coronary artery bypass grafting; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CS = cardiogenic shock; ECG = electrocardiography; eGFR = estimated glomerular filtration rate; ESC = European Society of Cardiology; GRACE = Global Registry of Acute Coronary Events; HF = heart failure; LVEF = left ventricular ejection fraction; MPI = myocardial perfusion imaging; MR = mitral regurgitation; NSTE-ACS = non-ST-segment elevation acute coronary syndromes; PCI = percutaneous coronary intervention; TIMI = thrombolysis in myocardial infarction

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Author information

Author notes

  1. Mohammad Keykhaei and Haleh Ashraf contributed equally.

Authors and Affiliations

  1. Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Keykhaei, Haleh Ashraf, Sina Rashedi, Hossein Farrokhpour, Shaghayegh Zokaei, Sayna Bagheri, Roham Foroumadi, Sara Asgarian & Aslan Amirian

  2. Department of Medicine, Houston Methodist Hospital, Houston, TX, USA

    Behnam Heidari

  3. Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, 11367-46911, Tehran, Iran

    Shahrokh Karbalai Saleh

  4. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 256, SE-751 05, 751 85, Uppsala, Sweden

    Stefan James

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Contributions

MM: original draft preparation, conceptualization, methodology, investigation. HA: original draft preparation, conceptualization, methodology, investigation. SR: original draft preparation, conceptualization, methodology, investigation. HF: original draft preparation, conceptualization, methodology, investigation. BH: review and editing, investigation, data curation. SZ: review and editing, investigation, data curation. SB: review and editing, investigation, data curation. RF: review and editing, investigation, data curation. SA: review and editing, investigation, data curation. AA: review and editing, investigation, data curation. SKS*: review and editing, conceptualization, methodology, supervision. SJ*: review and editing, conceptualization, methodology, supervision. All authors read and approved the final manuscript. *Corresponding authors.

Corresponding authors

Correspondence to Shahrokh Karbalai Saleh or Stefan James.

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Keykhaei, M., Ashraf, H., Rashedi, S. et al. Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHA Guidelines on the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation. Curr Atheroscler Rep 23, 77 (2021). https://doi.org/10.1007/s11883-021-00976-7

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