Thread by @CianPMcCarthy

My 15 highlights 💡from the 2020 ESC NSTE-ACS guideline:

1. Hs troponins recommeded over conventional assays 🧪
2. ESC 0'1 and 0'2 algorithms preferred over 0'3
3. TTE recommended for all patients.

4. If rule-out using ED algorithm but still have concern for ACS, a non-invasive modality is preferred to invasive coronary angio
5. Pre-treatment with P2Y12 not recommended prior to invasive coronary angiogram

6. Prasugrel preferred over ticagrelor if undergoing PCI 💊
7. Both preferred over clopidogrel unless not available
8. UFH preferred to LMWH for NSTEMI 💉

9. Invasive angiography recommended within 24 hours for "high-risk" patients. "Diagnosis of NSTEMI by algorithm" is considered high-risk.
10. If transient ST elevation and resolution of symptoms, invasive angiogram within 24 hours (rather than immediate) favored

11. CMR recommended for MINOCA cases without clear cause.
12. Advanced age should not change your diagnostic and therapeutic strategies.
13. LDL target is 55. Repeat in 4-6 weeks and add zetia if needed, repeat again in 4-6 weeks and add PCSK9 if needed

14. Long term beta blocker not routinely recommended in absence of LV dysfynction/HF. Can however consider it.
15. Notably, guideline did not differentiate type 1 and type 2 MI in their recommendations. Will you be applying these recommendations to your type 2 MI patients?!