ESC Updated Guidelines on Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation

by | Sep 1, 2020 | Blog

The European Society of Cardiology (ESC) Congress is a “heartbeat” of the industry, providing clinical practice guidance and insights that are widely accepted around the world. This year, the digital conference brought together over 116,000 healthcare professionals from 211 countries to discuss the latest insights in cardiovascular disease diagnosis and treatment. Prior to the conference, ESC published new clinical practice guidelines on managing Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation.

Acute coronary syndrome is an umbrella term used to describe a broad range of conditions that occur when the blood flow supplied to the heart is suddenly blocked. This includes conditions such as heart attack and unstable angina. According to ESC, patients with acute coronary syndromes often experience acute chest discomfort which may present itself as pain, pressure, tightness, and burning. The newly published guidelines include recommendations for how coronary computed tomography angiography (CCTA) should be used to diagnose and treat patients with low-to-intermediate likelihood of coronary artery disease.

Diagnosis of Acute Coronary Syndromes with CCTA

According to Section 3.3.5.2 Anatomical Evaluation, CCTA is now recommended as an alternative to invasive angiography to exclude acute coronary syndromes when there is a low-to-intermediate likelihood of coronary artery disease, and when cardiac troponin and/or ECG are normal or inconclusive [1]. This guideline was in part influenced by the results of the VERDICT trial which demonstrates that upfront imaging with CCTA reduces the need for invasive coronary angiography (ICA) [2].

Invasive Treatment

Section 6 on Invasive Treatment provides insight into when invasive strategies should be considered in treating acute coronary syndromes. The guidelines state that, following a selective invasive strategy, invasive coronary angiography (ICA) should only be performed after objective evidence of inducible ischemia on non-invasive testing or detection of obstructive coronary artery disease by CCTA [1].
These updated guidelines present new value as invasive procedures can carry risk and lead to potential complications. Replacing invasive testing with non-invasive methods can reduce the risk to patients while informing better treatment options.

Combining artificial intelligence with the data created by CCTA scans can introduce opportunities to provide more personalized and precise diagnostics. Keya Medical is working with clinicians globally to design solutions that can improve cardiovascular diagnostics.

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Bibliography

[1] Collet, J.P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., et al. “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, https://doi.org/10.1093/eurheartj/ehaa575.
[2] Kofoed, K.F., Kelbaek, H., Hansen, P.R., Torp-Pedersen, C., Høfsten, D., et al. “Early versus standard care invasive examination and treatment of patients with non-ST-segment elevation acute coronary syndrome: VERDICT Randomized Controlled Trial.” Circulation. 2018;138:2741-2750.