Since the last guideline update in 2012 (added to the 2007 guidelines), there have been a number of advances, including the expansion from NSTEMI to include unstable angina in the NSTEACS umbrella. If you already quite au fait with the previous version, this article provides a nice summary of the major changes in the new edition.
Some of the interesting updates are:
- CK-MB adds nothing to modern troponin assays in diagnosis, but may help estimate infarct size (although a day 3-4 troponin will also suffice)
- Inclusion of criteria for early invasive intervention:
- Immediate (within 2 hours): Patients with refractory or recurrent angina with initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation
- Early (within 24 hours): None of the immediate characteristics but new ST-segment depression, a GRACE risk score > 140, or temporal change in troponin
- Delayed invasive: None of the immediate or early characteristics but renal insufficiency, left ventricular ejection fraction (LVEF) < 40%, early post-infarct angina, history of percutaneous coronary intervention (PCI) within the past 6 months, prior coronary artery bypass surgery (CABG), GRACE risk score of 109-140, or TIMI score of 2 or higher
- Promotion of ticagrelor to first-line antiplatelet, next to clopidogrel
- Management for suspected cocaine or methamphetamine intoxication are provided: if signs of acute intoxication, benzos alone or in combination with GTN is given a Class IIa recommendation while β-blockers are given a Class III recommendation due to potential harm and risk of coronary vasospasm. If no signs of acute intoxication are present, patients with a history of cocaine or meth use should be treated identically to other patients (Class I indication)
You can find the "Executive Summary" in all of its 227-page glory published online at Circulation, or load it up right here by clicking the link below.