New European Heart Attack Recommendations Include Focus on Women

The 2020 recommendations focus on ultra-sensitive troponin assays with early diagnosis (one to two hours), coronary angiography in less then 24 hours and coronary CT scan to rule out diagnoses. Information specific to women is clearly detailed.

The European Society of Cardiology has updated its recommendations for managing non-ST-segment elevation myocardial infarction (NSTEMI); the previous recommendations dated from 2015. The committee was directed by Prof. Jean-Philippe Collet from Pitié-Salpêtrière Hospital.
This edition’s key takeaways include the essential use of biomarkers, with high-sensitivity troponin (hs-Tn) as the first choice. High-sensitivity troponin assay measurements enable rapid algorithms for diagnosis in one or two hours. NSTEMI can be ruled out if levels prove normal when considered in conjunction with a normal clinical examination and an ECG. However, variables modifying the normal hs-Tn ranges must be taken into consideration: age (difference between very young and very old healthy subjects), renal insufficiency (difference between normal and very impaired renal function), time from chest pain onset, and sex, with levels up to 40% lower in women. Other biomarkers are not routinely recommended. Using GRACE scores and natriuretic peptide assays allows for a more accurate prognosis.
Because of its excellent negative predictive value, a coronary CT scan is recommended to rule out coronary origin in low- and intermediate-risk situations seen in the emergency room. In other clinical situations where the estimated risk is at least moderate, a coronary angiography is recommended within 24 hours. With a rapid invasive approach, pretreatment with P2Y12 inhibitors is not recommended.
Finally, using an advanced diagnostic approach with documentation of types of myocardial infarction with non-obstructive coronary arteries (MINOCA), which predominantly affects women, is of interest.
In this 2020 edition, the term “women” appears 23 times. We thus note the consideration of female-specific aspects in relation to the physiopathological types more frequent in women: MINOCA, particularly microvascular heart disease; spontaneous coronary artery dissection. 4% of all acute coronary syndromes (ACS) but up to 35% of ACS in women under 60 years of age with no cardiovascular risk factors; and bleeding risk estimation with the need to adjust anticoagulant doses their body weight and renal function.
The supported consideration of female myocardial infarction specificities in these 2020 European guidelines underscores an improvement in gender-sensitive professional practices. These developments are essential to optimize follow-up care for these women and to anticipate heart attack recurrence by optimizing treatment, follow-up and gynecardiology coordination. Women’s Cardiovascular Healthcare Foundation’s missions include alerting and acting to share new information about cardiovascular disease management for women in order to save the lives of 10,000 women in 5 years.

https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-in-patients-presenting-without-persistent-ST-segm.