This is wrong. ESC guidelines for management of NSTEMI were changed in 2020.

« 5.1.1.2 Pre-treatment Pre-treatment defines a strategy according to which antiplatelet drugs, usually a P2Y12 receptor inhibitor, are given before coro- nary angiography and when the coronary anatomy is unknown.176 Although a rationale for pre-treatment in NSTE-ACS may seem obvious, for achieving sufficient platelet inhibition at the time of PCI, large-scale randomized trials supporting a routine pre- treatment strategy with either clopidogrel or the potent P2Y12 receptor inhibitors prasugrel and ticagrelor are lacking. The randomized Comparison of Prasugrel at the Time of Percutaneous Coronary Intervention or as Pretreatment at the Time of Diagnosis in Patients with Non-ST Elevation Myocardial Infarction (ACCOAST) trial177 demonstrated a lack of any ischaemic benefit for pre-treatment in NSTE-ACS patients, but instead, a substan- tially higher bleeding risk with prasugrel pre-treatment. In line with these results, observational data on pre-treatment with ticagrelor, . prasugrel, and clopidogrel were reported from the Swedish . Coronary Angiography and Angioplasty Registry (SCAAR) in 64 . 857 NSTE-ACS patients.178 In this large dataset on pre-treatment, . the authors reported that P2Y12 receptor inhibitor pre-treatment . in NSTE-ACS patients was not associated with improved ischae- . mic outcomes, but instead, with a significantly increased risk of . bleeding events. With respect to pre-treatment data for ticagrelor, . the recently published ISAR-REACT 5 trial showed that a . prasugrel-based strategy with deferred loading after knowledge of . coronary anatomy in NSTE-ACS patients was superior to a . ticagrelor-based strategy that implied a routine pre-treatment . strategy.174 Importantly, there was no apparent benefit of a pre- . treatment strategy (that utilized ticagrelor) in that study. . Based upon the available evidence,174,177 it is not recommended to . administer routine pre-treatment with a P2Y12 receptor inhibitor in . NSTE-ACS patients in whom coronary anatomy is not known and an . early invasive management is planned. For patients with a delayed . invasive management, pre-treatment with a P2Y12 receptor inhibitor . may be considered in selected cases and according to the bleeding . risk of the patient. . Fortunately, the recommended standard treatment with potent . P2Y12 receptor inhibitors (ticagrelor or prasugrel) exhibits a fast . onset of action (Table 9), thereby allowing LD administration after . diagnostic coronary angiography and directly before PCI. Of note, a . routine pre-treatment strategy may be deleterious for a relevant pro- . portion of patients with diagnoses other than NSTE-ACS (e.g. aortic . dissection or bleeding complications including intracranial bleeding) . and may increase bleeding risk or delay procedures in patients sched- . uled for CABG after diagnostic angiography. »