The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician

There have been significant advances in the diagnosis and management of non-ST-segment elevation myocardial infarction over recent years, which has been reflected in an international decline in mortality rates. This article provides an overview of the 2020 European Society of Cardiology Clinical Practice Guidelines for the topic, concentrating on areas relevant to the general or emergency physician. The recommendations and underlying evidence basis are analysed in three key areas: diagnosis (the recommendation to use high sensitivity troponin and how to apply it), pathways (the recommendation to facilitate early invasive coronary angiography to improve outcomes and shorten hospital stays) and treatment (a paradigm shift in the use of early intensive platelet inhibition). Gaps in the evidence base are highlighted, including the optimal management strategy for older people and the antiplatelet regime to consider when angiography may be delayed