What’s new in 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‑ segment elevation?

Overview

The article sumarizes the 2020 ESC Guidelines for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation. The diagnostics of ACS consists in assessment of chest pain, EKG and cardiac troponin. Troponin should be evaluated by high sensitivity assay. 0h/1h algorithms should be used to rule-in or rule-out ACS. Patients with a positive troponin have higher risk of cardivascular events and mortality and the early invasive treatment should be applied in these patients. In the guidelines several antithrombotic stretegies for different clinical conditions are mentioned, where the cornerstone for the length and intensity of antithrombotic treatment is the evaluation of bleeding risk. Further on the revascularization aspects and strategies are debated in the guidelines. Finally there are mentioned two specific conditions of ACS – Myocardioal infarction with non-obstructive coronary arteries and Spontaneous coronary artery dissection.

Keywords:

Troponin – "rule‑in" and "rule‑out" algorithms – antiplateled treatment – early invasive treatment – MINOCA – Myocardioal infarction with non‑obstructive coronary arteries and Spontaneous coronary artery dissection