• Am. J. Cardiol. · Mar 2015

    Review

    Updates and current recommendations for the management of patients with non-ST-elevation acute coronary syndromes: what it means for clinical practice.

    • Guillaume Cayla, Johanne Silvain, Jean-Philippe Collet, and Gilles Montalescot.
    • Service de Cardiologie, Centre Hospitalier Universitaire Nîmes (ACTION group, Université Montpellier 1), INSERM 937, Nîmes, France; Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (ACTION group, AP-HP, Université Paris 6), INSERM 937, Paris, France.
    • Am. J. Cardiol. 2015 Mar 14; 115 (5 Suppl): 10A-22A.

    AbstractThe American Heart Association (AHA) and the American College of Cardiology (ACC) have recently updated their joint guidelines for the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS, including unstable angina [UA] and non-ST-elevation myocardial infarction [NSTEMI]). These guidelines replace the 2007 guidelines and the focused updates from 2011 and 2012 and now combine UA and NSTEMI into a new classification, NSTE-ACS, and updating the terminology around noninvasive management to ischemia-guided strategy. The latest guidelines include updated recommendations for the use of the oral antiplatelet agents (P2Y12 inhibitors) prasugrel and ticagrelor as part of dual-antiplatelet therapy-the cornerstone of treatment for these patients. This report provides a comprehensive overview of the new and modified recommendations for the management of patients with NSTE-ACS and the evidence supporting them. Also, where appropriate, similarities and differences between the current recommendations of the AHA/ACC and those of the European Society of Cardiology (ESC) are highlighted. For example, the AHA/ACC recommends the P2Y12 inhibitor ticagrelor over clopidogrel in all patients with NSTE-ACS and clopidogrel, prasugrel, or ticagrelor for patients in whom percutaneous coronary intervention is planned, whereas the ESC guidelines specifically recommend individual P2Y12 inhibitors for particular patient subgroups.Copyright © 2015 Elsevier Inc. All rights reserved.

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