This site is intended for health professionals only

NICE: New guidelines for heart attack treatments

New guidelines for improving diagnosis and treatment of unstable angina and heart attacks have been released by the National Institute of Health and Care Excellence (NICE). 

Six new quality statements from NICE lay out the importance of treating heart attack patients quickly, and establishing their risk of future heart attacks or strokes. 

Adults who have had a type of heart attack called a non-ST-segment-elevation myocardial infarction (NSTEMI), or who have unstable angina, should be assessed for their risk of having further heart attacks or strokes in the future using an established risk scoring system that predicts six month mortality to guide treatment. 

Acute coronary syndromes cover a range of conditions including unstable angina, NSTEMI and ST-segment-elevation myocardial infarction (STEMI). All are due to a sudden reduction of blood flow to the heart, usually caused by the rupture of an atherosclerotic plaque within the wall of a coronary artery and may cause the formation of a blood clot. 

The quality standard also highlights the importance of preventing damage to the heart muscle by quickly unblocking the coronary artery and restoring adequate blood flow (coronary reperfusion) for people who have had an acute heart attack (STEMI). 

Adults with a STEMI who present within 12 hours of the onset of symptoms have primary percutaneous coronary intervention (PCIi), as the preferred means to widen the narrowed or blocked artery, as soon as possible but within 120 minutes of the time when fibrinolysisii could have been given. 

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Restoring an adequate coronary blood flow as quickly as possible during the acute phase of STEMI is a crucial factor in improving outcomes successfully since evidence suggests the majority of potentially salvageable heart muscle could be lost within 3 hours of the coronary artery being blocked."

She added: “The more heart muscle that is lost, the poorer the outcome for the patient. Apart from resuscitation if your heart stops, restoring blood flow to the heart as quickly as possible is the most important priority in people having an acute heart attack.” 

The full guidance on acute coronary syndromes is available on the NICE website