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National Clinical Guideline Centre (UK). Unstable Angina and NSTEMI: The Early Management of Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction. London: Royal College of Physicians (UK); 2010. (NICE Clinical Guidelines, No. 94.)

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  • November 2020: NICE's original guidance on Unstable angina and NSTEMI was published in 2010. See the NICE website for the guideline recommendations and for the 2020 Acute coronary syndromes update. This document preserves evidence reviews and committee discussions from the 2010 guideline. In November 2013, recommendation 1.3.6 was changed in line with recommendations in NICE's guideline on myocardial infarction. Recommendation 1.5.11 was updated to take into account people with a learning disability.

November 2020: NICE's original guidance on Unstable angina and NSTEMI was published in 2010. See the NICE website for the guideline recommendations and for the 2020 Acute coronary syndromes update. This document preserves evidence reviews and committee discussions from the 2010 guideline. In November 2013, recommendation 1.3.6 was changed in line with recommendations in NICE's guideline on myocardial infarction. Recommendation 1.5.11 was updated to take into account people with a learning disability.

Cover of Unstable Angina and NSTEMI

Unstable Angina and NSTEMI: The Early Management of Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction.

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Appendix AScope

1. Guideline title

Acute coronary syndromes: the management of unstable angina and non-ST segment elevation myocardial infarction

1.1. Short title

Acute coronary syndromes: unstable angina and NSTEMI

2. Background

  • The National Institute for Health and Clinical Excellence (‘NICE’ or ‘the Institute’) has commissioned the National Collaborating Centre for Chronic Conditions to develop a clinical guideline on acute coronary syndromes (unstable angina and non-ST segment elevation myocardial infarction) for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health (see appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.
  • The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical guidelines and technology appraisals published by the Institute after an NSF has been issued will have the effect of updating the Framework.
  • NICE clinical guidelines support the role of healthcare professionals in providing care in partnership with patients, taking account of their individual needs and preferences, and ensuring that patients (and their carers and families, where appropriate) can make informed decisions about their care and treatment.

3. Clinical need for the guideline

The term ‘acute coronary syndromes’ encompasses a range of conditions from unstable angina to ST elevation myocardial infarction (STEMI), arising from thrombus formation on atheromatous plaque. This guideline will address unstable angina and non-ST elevation myocardial infarction. Untreated the prognosis is poor and mortality is high, particularly in people who have had myocardial damage. Appropriate triage and timely use of acute interventions, whether invasive or pharmacological, are vital and will be addressed in this guideline. Timely assessment and classification of those presenting with undifferentiated chest pain are also important and is covered in the acute chest pain guideline being developed in parallel with this guideline see section 4.5.

4. The guideline

The guideline development process is described in detail in two publications that are available from the NICE website (see ‘Further information’). ‘The guideline development process: an overview for stakeholders, the public and the NHS’ describes how organisations can become involved in the development of a guideline. ‘The guidelines manual’ provides advice on the technical aspects of guideline development.

This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider. The scope is based on the referral from the Department of Health (see appendix).

The areas that will be addressed by the guideline are described in the following sections.

4.1. Population

4.1.1. Groups that will be covered

  • Adults (18 years and older), with a diagnosis of unstable angina or non-ST elevation MI.

Recommendations will be made, as appropriate and based on the evidence, for specific groups:

  • minority ethnic groups
  • older people
  • socio-economic groups
  • women
  • people with disabilities

4.1.2. Groups that will not be covered

  1. People with ST segment elevation myocardial infarction
  2. People with an ACS who have been discharged from hospital..
  3. People with acute heart failure not due to non-ST segment elevation myocardial infarction.
  4. People with undifferentiated chest pain.

4.2. Healthcare setting

The guideline will consider the care received in primary, secondary and tertiary healthcare centres, including care from ambulance teams and other paramedical staff before admission to hospital.

4.3. Clinical management

  1. Risk stratification for triage and management purposes.
  2. Percutaneous coronary intervention (PCI) or early coronary artery bypass grafting (CABG).
  3. Pharmacological therapies, for example antiplatelet drugs, anticoagulants, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors.
  4. Information-giving and communication in the early stage of treatment.

The guideline development group will take reasonable steps to identify ineffective interventions and approaches to care. If robust and credible recommendations for re-positioning the intervention for optimal use, or changing the approach to care to make more efficient use of resources, can be made, they will be clearly stated. If the resources released are substantial, consideration will be given to listing such recommendations in the ‘ ’ section of the guideline.

Note that guideline recommendations will normally fall within licensed indications; exceptionally, and only where clearly supported by evidence, use outside a licensed indication may be recommended. The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.

4.4. Status

4.4.1. Scope

This is the final scope.

4.5. Related guidance

The guideline being developed by the National Collaborating Centre for Primary Care ‘Acute chest pain: assessment, investigation and management of acute chest pain of suspected cardiac origin’ will address assessment and examination before diagnosis of the cause of the chest pain.

The following related NICE guidance will also be referred to as appropriate.

Published

In development

  • Acute chest pain: assessment, investigation and management of acute chest pain of suspected cardiac origin. NICE clinical guideline (publication anticipated December 2009).
  • Laser transmyocardial revascularisation for refractory angina pectoris. NICE interventional procedure guidance (publication date to be confirmed)
  • Percutaneous laser revascularisation for refractory angina pectoris. NICE interventional procedure guidance (publication date to be confirmed)

4.5.1. Guideline

The development of the guideline recommendations will begin in April 2008.

5. Further information

Information on the guideline development process is provided in:

‘The guideline development process: an overview for stakeholders, the public and the NHS’

‘The guidelines manual’.

These booklets are available as PDF files from the NICE website (www.nice.org.uk/guidelinesmanual). Information on the progress of the guideline will also be available from the website.

Referral from the Department of Health

The Department of Health asked the Institute:

To prepare a clinical guideline on the assessment and management of unstable angina and non-ST elevation myocardial infarction.

Copyright © 2010, National Clinical Guidelines Centre.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

The rights of the National Clinical Guidelines Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

Bookshelf ID: NBK62739
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