Acute coronary syndromes guideline gets overhaul
Experts discuss the primary updates and necessary consolidation of the critical care recommendations.
O’Donoghue, MD, MPH
In the latest guideline on acute coronary syndromes (ACS), numerous updates, improvements and insights add up to one big, cutting-edge picture.
The American Heart Association, in collaboration with the American College of Cardiology (ACC) and other organizations, published the new acute coronary syndromes (ACS) guideline in early 2025. The updated guideline aims to provide health care professionals with a comprehensive, evidence-based resource on how to best diagnose, treat and manage patients with ACS, including heart attack.
On Sunday morning, Marc Ruel, MD, MPH, and Michelle O’Donoghue, MD, MPH, co-led the session, “The New 2025 Guideline for Acute Coronary Syndromes,” to review key changes, challenging issues and important implementation advice.
The latest guideline features innovative strategies such as high-intensity statin therapy, dual antiplatelet therapy, timely revascularization and the use of nonstatin lipid-lowering agents for patients with elevated LDL cholesterol. Before the new guideline’s release, various, fragmented guidance dated back a decade or more, said Ruel, who is professor and director of minimally invasive cardiac surgery at the University of Ottawa, Canada.
“We needed to group together, update, critically appraise and reinvent the guideline,” he said. “For instance, many areas of lipid management, antiplatelet, shock management, completeness of revascularization and intracoronary imaging that received strong recommendations in the newest guideline reflect major advances that were not even dreamed of 10 years ago. As such, the information could not be found in a single document before, and we tried very hard to fix that.”
O’Donoghue, who is an associate professor of medicine at Harvard Medical School in Boston, highlighted differences in the 2025 ACC/AHA guideline and the European Society of Cardiology (ESC)’s 2023 ACS guideline. She was joined by consultant cardiac surgeon Patrick Myers, PD, who shared a global perspective on the topic.
“Heart attacks are absolutely central to medical care around the world,” O’Donoghue said. “The 2025 ACS guideline addresses so many new areas and puts all the relevant information under one roof for practitioners — whether you’re an interventional cardiologist, heart surgeon, critical care physician, general cardiologist, rehabilitation specialist, physiotherapist, nurse or family doctor in a rural community.”
The panelists also presented real-life cases to illustrate new approaches, unique patient pathways, practical applications and controversies they encountered along the way to consensus.
“We are biased, but we do feel this is the most important cardiac guideline, one that is critical to have handy,” Ruel said. “As we all know, lost time during ACS often turns out to be lost myocardium.”
