Acute Coronary Syndromes in Adults: Quality Standard

Overview

This specialist Guidelines summary covers quality standards for the diagnosis and management of acute coronary syndromes (including myocardial infarction) in adults aged 18 years and over. It does not cover the secondary prevention of cardiovascular disease after myocardial infarction, including rehabilitation; this is covered by a separate quality standard.

This summary is for use by cardiology teams. For information on rationales and quality measures, refer to the original quality standard (QS68) from NICE.

List of Quality Statements

Quality Statement 1: Diagnosis of Acute Myocardial Infarction

• Adults with a suspected acute coronary syndrome are assessed for acute myocardial infarction using the criteria in the universal definition of myocardial infarction.

Quality Statement 2: Risk Assessment for Adults With NSTEMI or Unstable Angina

• Adults with non-ST-segment-elevation myocardial infarction (NSTEMI) or unstable angina are assessed for their risk of future adverse cardiovascular events using an established risk scoring system that predicts 6-month mortality to guide clinical management. (See Box 1 and Table 1.)

Table 1: Categories for the Risk of Future Adverse Cardiovascular Events Using 6-month Mortality

Quality Statement 3: Coronary Angiography and PCI Within 72 Hours for NSTEMI or Unstable Angina

• Adults with non-ST-segment-elevation myocardial infarction (NSTEMI) or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events who are having coronary angiography (with follow-on percutaneous coronary intervention [PCI] if indicated), have it within 72 hours of first admission to hospital.

Quality Statement 4: Coronary Angiography and PCI For Adults With NSTEMI or Unstable Angina Who Are Clinically Unstable

• Adults with NSTEMI or unstable angina who are clinically unstable have coronary angiography (with follow-on PCI if indicated) as soon as possible, but within 24 hours of becoming clinically unstable.

Quality Statement 5: Level of Consciousness and Eligibility for Coronary Angiography and Primary PCI

• Adults who are unconscious after cardiac arrest caused by suspected acute ST-segment-elevation myocardial infarction (STEMI) are not excluded from having coronary angiography (with follow-on PCI if indicated).

Quality Statement 6: Primary PCI for Acute STEMI

• Adults with acute STEMI who present within 12 hours of onset of symptoms have primary PCI as the preferred coronary reperfusion strategy as soon as possible but within 120 minutes of the time when fibrinolysis could have been given.