ACC, AHA Issue New Acute Coronary Syndrome Guideline

February 27, 2025—The American College of Cardiology (ACC) and the American Heart Association (AHA) announced the release of an updated clinical practice guideline for managing patients experiencing acute coronary syndrome (ACS).

In addition to the ACC and AHA, the guideline was written in collaboration with and endorsed by the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Emergency Physicians (ACEP), and the National Association of Emergency Medical Services Physicians (NAEMSP).

According to the ACC and AHA press release, the guideline incorporates new evidence and updated recommendations to improve quality of care and outcomes. The recommendations reflect the best evidence to support ACS treatment and management, including updated pharmacologic and procedural care, noted the societies.

“The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes” by Sunil V. Rao MD, et al was published simultaneously online in the ACC and AHA’s respective flagship journals, JACC and Circulation.

“Patients with ACS are at the highest risk for cardiovascular complications both acutely and chronically, which emphasizes the importance of staying up to date on the most recent evidence presented in this guideline,” commented Dr. Rao in the societies’ press release. “With appropriate management, we can improve outcomes both in the hospital and over the long term.”

Dr. Rao, the chair of the guideline writing committee, is Professor of Medicine, the Leon H. Charney Division of Cardiology, Director of Interventional Cardiology at NYU Langone Health in New York, New York.

As summarized by ACC and AHA, the guideline focuses on the management of unstable angina and both non–ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction.

Recommendations address percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT), treating cardiogenic shock (CS), and secondary prevention after ACS.

As summarized in the press release, the guideline includes the following:

• For PCI, the guideline stresses the importance of the radial approach over a femoral approach to reduce the risk of bleeding, vascular complications, and death.
• To guide the PCI procedure, intravascular imaging is now a class 1, level of evidence A recommendation.
• DAPT is already recommended for patients with ACS reduces the risk of recurrent myocardial infarction, but it can increase bleeding risk in some patients.
• DAPT is recommended for at least 12 months after hospital discharge for patients with low bleeding risk; several strategies are recommended for patients with a higher bleeding risk.
• For treating CS, the guideline recommendations include prompt revascularization as fundamentally important with a class 1 recommendation.
• For the CS recommendations, recent clinical trial data is incorporated, as well as consideration of new therapies, such as the microaxial flow pump, based on the benefits and risks for each patient.
• For secondary prevention after ACS, the recommendation focused on reducing progression, recurrence, or complications, is fundamental in the recovery process.

The take-home messages from the document are outlined in “2025 ACS Guideline-at-a-Glance,” which was published by Dharam J. Kumbhani, MD, et al online in JACC.