Acute coronary syndromes: considerations for improved acceptance and implementation of management guidelines

Abstract

The management of acute coronary syndrome in Europe is covered by various European Society of Cardiology guidelines, which although valuable, are complex and may not always provide clear guidance in everyday clinical practice. Consequently, implementation of the guideline recommendations is frequently suboptimal. To complicate matters further, a wealth of new data from large trials examining novel anti-thrombotic agents will become or are already available, necessitating guideline updates. This article summarizes the gaps between current guideline-recommended treatment of acute coronary syndrome and daily practice as dictated by the evidence base, including recent trials. Reasons for the suboptimal implementation of the current European Society of Cardiology guidelines and possible solutions to making these more practice oriented are presented.

Keywords::

• acute coronary syndromes
• antiplatelet agents
• bleeding
• coronary artery bypass grafting
• guidelines
• percutaneous coronary intervention
• trials

Financial & competing interests disclosure

F Van de Werf has received consulting fees and research grants from Boehringer Ingelheim and Merck, and consulting fees from Roche, sanofi-aventis, AstraZeneca and The Medicines Company. D Ardissino has received research grants from AstraZeneca, Ely Lilly, Daichii Sankyo, sanofi-aventis, BMS, The Medicines Company, Novartis, Sorin and Medtronic, and consulting fees from AstraZeneca, Ely Lilly, Daichii Sankyo, sanofi-aventis, BMS, The Medicines Company, Novartis, MSD, Bayer, Pfizer and Boehringer Ingelheim. H Bueno has received consulting fees from Almirall, AstraZeneca, Bayer, BMS and sanofi-aventis, and research grants from BMS and Pfizer. J-P Collet has received speakers fees from sanofi-aventis, AstraZeneca, Daichii-Sankyo and Nycomed. A Gershlick has received fees for being on the advisory boards and lecture bureaus of The Medicines Company, Eili Lilly, Medtronic Corp. and Abbott Vascular. P Kolh has received consulting or speakers fees from AstraZeneca, Abbotts Vascular, Bristol-Myers Squibb, Merck and Regardo Biosciences. SD Kristensen has received speakers fees from AstraZeneca, Daiichi-Sankyo, Eli Lilly, Merck and The Medicines Company. S Silber has received speakers fees from AstraZeneca, Daichii-Sankyo, Eli Lilly and sanofi-aventis. FWA Verheugt has received educational and research grants from Bayer AG, Roche, Eli Lilly and Boehringer Ingelheim, and honoraria for consultancies from Daiichi-Sankyo, Eli Lilly, Merck, The Medicines Company and Bayer AG. The meeting on which this report was based was sponsored by AstraZeneca but the manuscript was developed independently from the sponsor. Responsibility for opinions, conclusions and interpretation of the data lies with the authors. Employees of AstraZeneca were permitted to read the final draft of the manuscript and make comments on scientific and technical accuracy only. It was the authors’ decision whether to accept or reject any suggestions made by AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors thank L Anfield from Prime Medica Ltd (Knutsford, Cheshire), who provided editorial assistance during the development of the manuscript, funded by AstraZeneca.