Practice-Changing Updates in ACS Management – ACC.25 Summary
Practice-Changing Updates in ACS Management – ACC.25 Summary
Source: ACC.25 – Presented by Dr. Deepak Bhatt | April 2025
1. No Need for Fasting Before Cardiac Cath:
• Recent RCTs and meta-analysis show no increase in adverse events in non-fasting patients.
• Fasting may reduce satisfaction and complicate diabetes management.
• Especially in elective cases, fasting is unnecessary.
2. Avoid unnecessary combination of antithrombotic agents.
In patients with AF and stable CAD, the addition of aspirin to oral anticoagulation increases bleeding risk without providing additional ischemic protection, according to recent evidence.
Despite these findings, dual therapy is still frequently prescribed in practice.
Clinicians are encouraged to reassess the need for antiplatelet therapy in this population and align management with current guidelines that support anticoagulation monotherapy in stable casStudies such as ALT-DAPT and HOST-BR RCT suggest that shortening the duration of dual antiplatelet therapy (DAPT) to 1–3 months may be safe and effective in certain patients, particularly those at high risk of bleeding. Among these durations, 3 months appears to provide a good balance between reducing ischemic events and minimizing bleeding risk—hence, it is considered the “sweet spot” for many patients.
4. Mixed Results in Mechanical Support Trials:
• ECMO showed no survival benefit in a randomized trial.
• Impella (DanGer Shock trial) showed possible mortality benefit but with more bleeding and vascular complications.
5. Colchicine Shows No Benefit in ACS (CLEAR-SYNERGY Trial):
• Despite lowering CRP, colchicine did not improve outcomes post-PCI.
• Contradicts earlier smaller trials; not recommended in ACS.
• Ongoing interest in IL-6 inhibition (ARTEMIS trial underway).
6. SGLT2 Inhibitors in ACS:
• DAPA-MI and EMPACT-MI: no MI reduction in ACS patients.
• Sotagliflozin (SGLT1/2) showed reduced MI and stroke in non-ACS populations.
• Potential role in ACS, but further trials needed.
7. Polypill Strategy Post-MI (SECURE Trial):
• A cardiovascular polypill improves adherence and outcomes post-MI.
• Emphasizes long-term management, lifestyle changes, and medication simplicity.
🔗 ACC 2025 Clinical Trials to Watch with Deepak Bhatt, MD, MPH, MBA
