Updates to the ACCF/AHA and ESC STEMI and NSTEMI Guidelines: Putting Guidelines Into Clinical Practice

Variations in patient care have been shown to result in disparities in patient outcomes, whereas protocols streamline the clinical decision-making process and reduce variation.1 By enhancing the speed and accuracy of evaluation and treatment, efficiency can be optimized and outcomes improved.2 Clinical protocols were first applied to the management of acute coronary syndromes (ACS) in the 1990s through algorithms used to manage patients with acute chest pain.3 Effective protocols have since emerged as a means to improve patient outcomes by standardizing and coordinating care from presentation to postdischarge and subsequent follow-up.4,5 Although protocols can serve as a useful guide for providers, modifying care according to individual patient characteristics and specific clinical situations is essential to ensure appropriate provision of care. Updates to Guidelines In 2013, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) published guidelines for the management of ST-elevation myocardial infarction (STEMI) that replaced the 2004 guidelines and subsequent updates published in 2007 and 2009.9 Similar guidelines for the management of STEMI were published by the European Society of Cardiology (ESC) in 2012, replacing previous guidelines from 2003 and corresponding update in 2008.10 Guidelines for non-ST-elevation myocardial infarction (NSTEMI) were published by the ACCF/AHA and ESC in 2012 and 2011, respectively, replacing previous versions from 2007.11,12 In the most recent guidelines for the management of STEMI, particular emphasis is placed on the development and organization of systems of care, including algorithms for patient transfer to percutaneous coronary intervention (PCI)-capable facilities.