Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
Date Issued
2021-02-26
Author(s)
Giannitsis, Evangelos
Blankenberg, Stefan
Christenson, Robert H
Frey, Norbert
von Haehling, Stephan
Hamm, Christian W
Inoue, Kenji
Katus, Hugo A
McCord, James
Möckel, Martin
Chieh, Jack Tan Wei
Tubaro, Marco
Wollert, Kai C
Huber, Kurt
Abstract
Multiple new recommendations have been introduced in the 2020 ESC guidelines for the management of acute coronary syndromes with a focus on diagnosis, prognosis, and management of patients presenting without persistent ST-segment elevation. Most recommendations are supported by high-quality scientific evidence. The guidelines provide solutions to overcome obstacles presumed to complicate a convenient interpretation of troponin results such as age-, or sex-specific cutoffs, and to give practical advice to overcome delays of laboratory reporting. However, in some areas, scientific support is less well documented or even missing, and other areas are covered rather by expert opinion or subjective recommendations. We aim to provide a critical appraisal on several recommendations, mainly related to the diagnostic and prognostic assessment, highlighting the discrepancies between Guideline recommendations and the existing scientific evidence.
Subjects
Acute coronary syndromes; Critical appraisal; Diagnosis; Guidelines; High-sensitivity troponin; Management; Non-ST-segment elevation; Prognosis
SDGs
Other Subjects
adrenomedullin; copeptin; troponin I; troponin T; troponin; acute coronary syndrome; acute heart infarction; Article; blood clot lysis; cardiovascular disease; cardiovascular risk; controlled study; coronary angiography; coronary artery disease; creatinine blood level; diagnostic test accuracy study; electrocardiography; heart stress; human; length of stay; limit of detection; major adverse cardiac event; non st segment elevation acute coronary syndrome; observational study; percutaneous coronary intervention; practice guideline; predictive value; prognostic assessment; prospective study; randomized controlled trial; right coronary artery; risk assessment; risk factor; ST segment elevation myocardial infarction; thorax pain; unstable angina pectoris; acute coronary syndrome; Europe; female; male; metabolism; non ST segment elevation myocardial infarction; practice guideline; prognosis; Acute Coronary Syndrome; Europe; Female; Humans; Male; Non-ST Elevated Myocardial Infarction; Practice Guidelines as Topic; Prognosis; Risk Assessment; Troponin
Type
journal article