The year in cardiology 2015: acute coronary syndromes

Abstract

The year 2015 has been productive in studies on pathophysiology of ACS. In particular on the different mechanisms of disease and related outcomes. New information has been published on the early diagnosis of ACS and on prevention and treatment of microvascular obstruction. With regard to antithrombotic treatment, the year 2015 has brought important new data that will change practice. Both the European Society of Cardiology (ESC)1 and the American College of Cardiology/American College of Cardiology (ACC/AHA)2 have published new guidelines on the management of acute coronary syndromes (ACS) in patients without persistent ST-segment elevation. In this review, we briefly highlight new recommendations only. With regard to early diagnosis of myocardial infarction (MI) ESC guidelines, for the first time, give a 1B recommendation for a rapid rule-out and rule-in protocol at 0 and 1 h if a high-sensitivity cardiac troponin test with a validated 0/1 h algorithm is available, with additional testing after 3–6 h if the first two troponin measurements are not conclusive and the clinical condition is still suggestive of ACS, while ACC/AHA recommend to measure troponin at presentation and 3–6 h after symptom onset. Both guidelines recommend an immediate invasive strategy within 2 hours of presentation in very high-risk patients, an early invasive strategy within 24 h in high-risk patients and an invasive strategy within 72 h in intermediate risk patients. Finally, ESC guidelines give 1A recommendation for the radial approach in experienced centres and provide a new flow chart for the management of antithrombotic drugs in patients with concomitant non-valvular atrial fibrillation ( Figure 1 ). They also give for the first time 3B recommendation for not to preloading patients in whom …