The 2025 ACC/AHA guidelines for managing acute coronary syndromes (ACS) have introduced several updates compared to previous guidelines.
The 2025 ACC/AHA guidelines for managing acute coronary syndromes (ACS) have introduced several updates compared to previous guidelines. Key differences include:
• Dual Antiplatelet Therapy (DAPT): For ACS patients not at high bleeding risk, DAPT with aspirin and a P2Y12 inhibitor is recommended for at least 12 months. For those at higher bleeding risk, alternative strategies are suggested.
• Lipid Management: High-intensity statin therapy is advised for all ACS patients. If LDL-C levels remain ≥70 mg/dL (1.8 mmol/L) despite maximally tolerated statins, adding non-statin lipid-lowering agents like ezetimibe, evolocumab, alirocumab, inclisiran, or bempedoic acid is recommended.
• Percutaneous Coronary Intervention (PCI) Approach: The guidelines now emphasize the radial (wrist) approach over the femoral (groin) approach for PCI in ACS patients to reduce bleeding, vascular complications, and mortality.
• Intravascular Imaging: Utilizing intravascular imaging to guide PCI procedures has been elevated to a Class 1 recommendation, reflecting its importance in improving outcomes.
• Complete Revascularization: For patients with STEMI or non-STEMI ACS, a strategy of complete revascularization is recommended, with the method chosen based on coronary artery disease complexity and comorbidities.
• Cardiogenic Shock Management: Prompt revascularization remains crucial. New recommendations include considering microaxial flow pumps for select patients, with careful attention to vascular access and support weaning to balance benefits and risks.
• Secondary Prevention: Post-discharge, the guidelines recommend:
• Referral to outpatient cardiac rehabilitation (or home-based programs if outpatient services are unavailable).
• Conducting a fasting lipid panel 4 to 8 weeks after starting or adjusting lipid-lowering therapy to assess effectiveness and determine if additional medications are needed.
These updates aim to enhance the quality of care and outcomes for ACS patients by integrating the latest evidence-based practices.
Download PDF file (Guideline_for_the_Management_of_Patients)
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