Feature Article

Non-ST-segment elevation acute coronary syndrome: a missed chance or the opportunity for effective therapy?

Con Aroney



Non-ST-segment elevation acute coronary syndrome is often a marker for severe, prognostically important and activated coronary disease. Failure to recognise and aggressively treat patients with this syndrome may result in a lost opportunity for early effective therapy.

Key Points

  • Discuss with all adults, particularly those with cardiac risk factors, how they should respond to chest discomfort, and provide them with a patient handout explaining what to do.
  • Advanced age, diabetes and chronic kidney disease increase the likelihood of a coronary aetiology of chest discomfort, even in patients with atypical symptoms, and are strongly associated with prognosis.
  • A normal physical examination, ECG or troponin level does not rule out prognostically important activated coronary disease.
  • Ambulance transport to hospital is strongly recommended, particularly for patients with ongoing, recently prolonged or repetitive symptoms.
  • Assessment of patients with possible acute coronary syndrome requires protocol driven investigations in a monitored emergency department or hospital setting.
  • Early aggressive medical and invasive management and long term lifestyle modification and pharmacological therapy are associated with good long term patient outcomes.