The annual congress of the European Society of Cardiology provided a platform for the presentation of more than 4,000 clinical abstracts by scientists from around the world. It also recorded the publication of four new or updated guidelines. We report some key points of the new guidelines for the management of non-ST segment elevation acute coronary syndromes.
For the first time ever, the annual ESC Scientific Congress was held as a "The Digital Experience" due to the COVID-19 pandemic. However, this did not dampen the enthusiasm around the congress, which this year recorded a record number of participants (more than 100,000 on the first day) and perhaps represented a real digital revolution in cardiovascular learning and sharing.
In 2020, leaving aside COVID-19, cardiovascular diseases, particularly ischemic heart disease, still remain the leading cause of death in the world. The ESC's mission is to reduce the global impact of cardiovascular disease. Among the various actions conducted by the ESC is the publication of clinical practice guidelines that provide recommendations for optimizing treatment based on the best evidence. New guidelines for the management of acute coronary syndromes in non-ST segment elevation patients were presented during the conference, among others.
The majority of patients with ischemic heart disease present an acute coronary syndrome without ST elevation (NSTE-ACS). The management of NSTE-ACS begins with the correct diagnosis, the appropriate and timely initiation of appropriate therapy, the execution of hemodynamic procedures, and secondary preventive care. 5 years after the latest ESC guidelines for NSTE-ACS, which novelties in the guidelines will influence or change clinical practice? First of all, the new ESC 2020 guidelines have introduced new sections on the following important topics:
The new ESC 2020 guidelines also contain new or updated recommendations on:
The COVID-19 pandemic has caused hospitalizations for myocardial infarction to halve worldwide, probably, among other reasons, for fear of going to a hospital and being infected. However, NSTE-ACS is a life-threatening condition, and therefore calling for help when symptoms occur is essential to save lives and avoid future complications, including heart failure.
The new ESC guidelines have emphasized the importance of evaluating clinical presentation and explain that: Typical chest pain is characterized by a retrosternal pain sensation, pressure or heaviness ('angina') radiating to the left arm, both arms or the right arm, neck, or jaw, which can be intermittent (usually lasting several minutes) or persistent. Additional symptoms such as sweating, nausea, epigastric pain, dyspnea, and syncope may be present. Atypical presentations include isolated epigastric pain, indigestion-like symptoms, and isolated dyspnea or fatigue. Atypical disorders are most often observed in the elderly, women, and patients with diabetes, chronic kidney disease, or dementia. The exacerbation of physical exertion symptoms and their relief at rest increase the likelihood of myocardial ischemia.
1. Jean-Philippe Collet, Holger Thiele, Emanuele Barbato, Olivier Barthélémy, Johann Bauersachs, Deepak L Bhatt, Paul Dendale, Maria Dorobantu, Thor Edvardsen, Thierry Folliguet, Chris P Gale, Martine Gilard, Alexander Jobs, Peter Jüni, Ekaterini Lambrinou, Basil S Lewis, Julinda Mehilli, Emanuele Meliga, Béla Merkely, Christian Mueller, Marco Roffi, Frans H Rutten, Dirk Sibbing, George C M Siontis, ESC Scientific Document Group, 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC), European Heart Journal, ehaa575, https://doi.org/10.1093/eurheartj/ehaa575
2. Mukherjee D. 2020 ESC NSTE-ACS Guidelines: Key Points. American College of Cardiology Foundation. Aug 29, 2020
3. Kunadian V. What’s new in the 2020 ESC Clinical Practice Guideline on the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS)?. PCR Online. 29 Aug 2020
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