Home Messages – Key Updates in Acute Coronary Syndrome (ACS) Care
Home Messages – Key Updates in Acute Coronary Syndrome (ACS) Care
1. Fasting before cardiac catheterization might not be necessary. New research shows no increase in complications for non-fasting patients and better overall satisfaction. This challenges the traditional practice of fasting, especially in elective cases.
2. Adding aspirin to oral anticoagulants in patients with atrial fibrillation and stable coronary artery disease leads to more bleeding without extra protection from heart attacks or strokes. This suggests we should stop combining antithrombotic medications unnecessarily.
3. Shortening the duration of dual antiplatelet therapy (DAPT) after PCI could be safe for many patients. Some trials support stopping after just one to three months, especially for those at high risk of bleeding. Treatment should be tailored to each patient.
4. Mechanical support devices in ACS show mixed results. ECMO did not show benefit, while Impella may reduce death but causes more bleeding and complications. More research is needed to define the best use of these technologies.
5. Colchicine, a drug that lowers inflammation, did not reduce cardiovascular events after PCI in ACS patients in the CLEAR-SYNERGY trial, even though it reduced inflammatory markers like CRP. It currently has no clear role in acute care.
6. SGLT2 inhibitors have not shown benefit in reducing heart attacks in ACS patients. However, sotagliflozin, which also blocks SGLT1, reduced heart attacks and strokes in other patient groups. More research is needed to confirm its role in ACS.
7. Managing ACS does not end after hospital discharge. Long-term treatment, lifestyle changes, and medication adherence are crucial. A polypill that combines several heart medications may help improve patient outcomes, as shown in the SECURE trial.
Publication date: April 21, 2025
Source: Cardiovascular Business. Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital and the Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine