Highlights: Comparison of ESC vs. ACC/AHA ACS Guidelines
Highlights: Comparison of ESC vs. ACC/AHA ACS Guidelines
• Integration & Evidence Base:
• ACC/AHA: Combines data from multiple previous guidelines to form a unified, updated approach for ACS management.
• ESC: Emphasizes early, aggressive intervention—particularly in lipid management—with targets such as LDL‑C <55 mg/dL.
• Dual Antiplatelet Therapy (DAPT):
• ACC/AHA: Recommends at least 12 months of DAPT (aspirin plus a P2Y12 inhibitor), with ticagrelor or prasugrel preferred for PCI patients; supports transitioning to monotherapy after 1 month in selected cases.
• ESC: Endorses 12-month DAPT as well but allows for de-escalation to single antiplatelet therapy after 3–6 months in patients at lower ischemic risk or higher bleeding risk.
• Lipid Management:
• ACC/AHA: Advocates high‑intensity statin therapy for all ACS patients, with the addition of non‑statin agents (e.g., ezetimibe or PCSK9 inhibitors) if LDL‑C remains ≥70 mg/dL or for patients with LDL‑C in the 55–69 mg/dL range.
• ESC: Also starts high‑intensity statins early but sets a more aggressive LDL‑C target (<55 mg/dL), with further intensification (e.g., aiming for <40 mg/dL) in recurrent events.
• Revascularization Strategies:
• ACC/AHA: Recommends complete revascularization for stable patients with multivessel disease—either during the index procedure or staged—and advocates culprit‑only PCI in cardiogenic shock.
• ESC: Supports complete revascularization in hemodynamically stable patients, favoring index‑procedure revascularization in STEMI, while recommending a cautious, staged approach in the setting of cardiogenic shock.
• Bleeding Risk Management:
• ACC/AHA: Utilizes strategies such as proton pump inhibitor use, early transition to monotherapy, or de‑escalation in high‑bleeding‑risk patients; suggests discontinuing aspirin 1–4 weeks post‑PCI when combined with oral anticoagulation.
• ESC: Adopts a similar risk‑adjusted approach with individualized DAPT duration and transitions based on bleeding risk profiles.
• Implementation & Dissemination:
• ACC/AHA: Focuses on practical tools like central illustrations and comparison tables to enhance guideline adoption across clinical, educational, and policy domains.
• ESC: Emphasizes streamlined protocols and clear targets to drive early and intensive intervention in ACS care.