New ESC Guidelines for the management of non-ST segment elevation acute coronary syndromes (NSTE-ACS) have been published. The guidelines detail the latest evidence based recommendations concerning the diagnosis and management of this syndrome, which is one of the main causes of cardiovascular morbidity and mortality in Europe. Information from the most recent randomized clinical trials has been incorporated in order to make these new guidelines as comprehensive, and as up-to-date as possible. The guidelines have been published online and in the European Heart Journal, official journal of the ESC, and Europe's leading cardiology journal.

The guidelines present a comprehensive strategy for the management of NSTE-ACS, covering diagnostic procedures (especially use of biomarkers), the optimal pharmacological environment, with respect to all the new drugs available, and indications for invasive evaluation and revascularisation strategies.

The new guidelines include recommendations for the management of ACS in special situations that have often not been addressed in previous guidelines. Specific sections are dedicated to special patient populations such as the elderly and women. The guidelines also include recommendations on how the manage patients with chronic renal failure, diabetes, anaemia and bleeding complications.

This last point is particularly important, as underlined by Professor Jean-Pierre Bassand, co-chair of the Task Force: "Bleeding has emerged as a major contributor to risk in patients suffering from acute coronary syndromes, and needs to be taken into account when evaluating risk and deciding on a treatment strategy. The prevention of bleeding has become equally as important an objective as the prevention of ischaemic events."

Other complications such as thrombocytopenia are also cited, as well as recommendations for dealing with specific aspects such as resistance to antiplatelet agents, or premature withdrawal of treatment.

A clear and comprehensible outline of the best management strategy is given, and it is hoped that the succinct summaries of the main recommendations will make these guidelines easy to read and put into practice. "These guidelines will serve the physician in successfully managing this high risk population in the daily routine", points out Prof. Hamm, co-chair of the Task Force.

These new ESC Guidelines also include a chapter about performance measures, an important new concept whose importance has become increasingly clear during the past few years. The huge number of clinical practice guidelines available in the literature, and the increasing number of organisations and societies producing them, makes it difficult for many clinicians to stay abreast of the latest and most reliable information. Many guidelines exist, without ever being implemented in clinical practice simply because the physicians who are the target audience do not know that guidelines exist. The resulting variations in clinical practice can have repercussions on patients' outcomes. Regular monitoring of performance indicators can help to increase uptake into clinical practice, thereby improving outcomes.

The Euro Heart Survey Acute Coronary Syndromes Registry is a new initiative of the ESC that enables participating hospitals to compare their practise with the new guidelines recommendations. Hospitals are provided with bench mark reports presenting key quality indicators selected from the ESC Guidelines allowing centres to monitor their own practise. For more information about the Acute Coronary Syndromes Registry visit the website.

It is anticipated that the new ESC Guidelines on the diagnosis and management of non-ST segment elevation acute coronary syndromes will become the reference for clinicians across Europe and elsewhere.

The guidelines were researched and written by the ESC Task Force on NSTE-ACS, and were co-chaired by Prof. Jean-Pierre Bassand, Past-President of the European Society of Cardiology, and Chief of the Cardiology Department in Besanšon, France; and Prof. Christian Hamm, Medical Director of the Kerckhoff Heart Centre in Bad Nauheim, Germany.

The European Society of Cardiology (ESC):
The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.

The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.org.

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