Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)



Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) accounted for 55.4% of all Acute Coronary Syndrome (ACS) reported from the National Cardiovascular Disease Database (NCVD) - ACS Registry between 2016 and 2017. NSTE-ACS including the non-ST elevation myocardial infarction and unstable angina is the dominant clinical manifestation of ACS in Malaysia hence ensuring the standardised and current clinical management for our clinicians is paramount for the safety of our patients.

A multi-pronged approach has seen improvement in the management of ACS over the last decade, in line with the development of both treatments and healthcare service delivery. However, since the publication of the previous Clinical Practice Guidelines (CPG) for the management of NSTE-ACS in 2011, new diagnostic and therapeutic measures have been introduced and practised. Therefore, the publication of the refreshed version of the 2021 Third Edition Clinical Practice Guideline on the Management of ST-Elevation Myocardial Infarction is timely.

Amongst the areas of focus in this brand-new CPG would be the in pre-hospital care, the use of cardiac troponins in the diagnostic work-up, a greater emphasis on risk stratification scores early in the inpatient management, and also the recommendation of an early invasive strategy for patients at the highest risk of adverse outcomes.

I am delighted with the research contribution by the various clinical and academic groups for the reference in this CPG, and I encourage such endeavours to continue for the improvement in both care and outcomes in patients. This CPG complements others that focus on the risk factors associated with the condition, including its sister condition, ST-elevation ACS in the CPG STEMI, 2019.

I thank the members of the Expert Panel and the External Reviewers, drawn from both the public and private sector of the Malaysian healthcare ecosystem, for their tireless work to produce this CPG. I would also like to acknowledge the National Heart Association of Malaysia and my colleagues at the Ministry of Health Malaysia for publishing this important update on the management of NSTE-ACS, 2021.


Tan Sri Dato' Seri Dr. Noor Hisham Bin Abdullah

Director-General of Health Malaysia, Ministry of Health Malaysia



Statement of intent:

This Guidelines was developed to be a guide for best clinical practice in the management of Non- ST Elevation Acute Coronary Syndrome (NSTE-ACS). This is a combination of both Unstable Angina (UA) and Non-ST Elevation Myocardial Infarction (NSTEMI). It is based on the best evidence currently available. Adherence to this Guidelines does not necessarily lead to the best clinical outcome in individual patient care. Thus, every health care provider is responsible for the management of his/her unique patient, based on the clinical presentation and management options available locally.


Review of the guideline:

This Guideline was issued in 2021 and will be reviewed in 2026 or earlier if important new evidence becomes available.


Click on the link below to download the full copy in PDF: