New guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction (termed acute coronary syndromes) have been released by the American College of Cardiology and the American Heart Association. The guidelines were created by a consortium of national experts including a cardiologist from Baylor College of Medicine.

"This important document is an update of the 2007 ACC/AHA guidelines. We examined past recommendations, reviewed the clinical data that accrued since then, and created the most updated set of recommendations that can provide guidance for physician in their patient care," said Dr. Hani Jneid, assistant professor of medicine and interventional cardiologist at Baylor College of Medicine and the Michael E. DeBakey VA Medical Center. Dr. Jneid was part of the 15-member writing group, led by Dr. R. Scott Wright, professor of medicine at the Mayo Clinic.

Leading cause of death

Unstable angina occurs when the heart doesn't get enough blood flow and oxygen, as a result of blockage in one or more of the coronary arteries. This results in chest discomfort, and when prolonged beyond a 20-30 minute period, may progress into myocardial infarction (or a heart attack) with death of heart muscle cells. Those guidelines therefore address one of the most commonly encountered clinical conditions and a leading cause of death and morbidity in the United States and the Western World.

Jneid indicated that the guidelines have been updated with a plethora of new recommendations. These include, but are not limited to, recommendations pertinent to early hospital care, such as the timing of cardiac catheterization after an acute coronary syndrome, the use of intravenous anti-platelet and anticoagulant medications, and especially the clinical application of prasugrel, a novel oral anti-platelet drug. New recommendations pertinent to patients with diabetes and chronic kidney disease, as well as recommendations for quality of care and outcome monitoring after an acute coronary syndrome have also been proposed.

Clinically relevant changes

"Our multifaceted group worked tirelessly to review the literature and dissect clinical studies and experimental evidence to come up with the meticulous and clinically relevant changes," Jneid said. "This process of periodically updating Guidelines is very important to patient care, especially in the dynamic and rapidly evolving field of cardiovascular medicine. The careful revisions and scrutiny of the document and the choice of unbiased and balanced team of experts are all a testimony of the high standards set by the ACC and AHA in constructing these guidelines, as supported by report of the Institutes of Medicine last month."

In addition to Drs. Scott and Jneid, the national expert panel is made up of Drs. Jeffrey Anderson, Cynthia Adams, Charles Bridges, A. Michael Lincoff, Donald Casey, Eric Peterson, Steven Ettinger, George Philippides, Francis M Fesmire, Pierre Theroux, Theodore Ganiats, Nanette Wenger and James Zidar. Of note, this guidelines update was created in collaboration with prominent medical organizations, including the American Academy of Family Physicians, the American College of Emergency Physicians, the Society for Cardiac Angiography and Interventions, and the Society of Thoracic Surgeons.

The 2011 focused update will be published in the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association. It has been released online ahead of print on the ACC and AHA web sites.