Updated Guidance Emphasizes the Latest Best Practices for Pharmacologic & Surgical Care in Patients with Sudden Reduced Blood Flow to the Heart Muscle
“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,” said Dr. Sunil Rao.
Credit: Joe Carrotta
The American Heart Association and the American College of Cardiology have recently released updated clinical guidelines focused on the best practices for managing individuals experiencing acute coronary syndrome (ACS). Sunil Rao, MD, director of interventional cardiology at NYU Langone Heart and professor in the , the at NYU Grossman School of Medicine, led this effort as the chair of the guideline writing committee. The document, published February 27 in and the , integrates the latest evidence and recommendations to improve quality of care and outcomes.
ACS refers to a group of acute cardiovascular conditions characterized by sudden reduced blood flow to the heart muscle, causing symptoms like chest pain, shortness of breath, and dizziness. Associated conditions include unstable angina (chest pain) and myocardial infarction (MI, or heart attack), which occur when an unstable cholesterol plaque in a coronary artery erodes or ruptures, leading to the formation of blood clots that reduce or completely block blood flow to the heart muscle. Each year, more than 800,000 people in the United States have a heart attack.
“Patients with ACS face the highest risk for both acute and chronic cardiovascular complications, underscoring the importance of staying current with the latest evidence in this guideline,” said Dr. Rao. “By providing appropriate management, we can improve outcomes both during hospitalization and in the long term.”
Key Updates in ACS Management
The guideline focuses on the management of chest pain and heart attack. Recommendations on both pharmacologic and procedural interventions include the following:
- Dual Antiplatelet Therapy (DAPT): The guideline reinforces the use of DAPT—aspirin combined with a P2Y12 inhibitor—for at least 12 months after a hospital stay in low-bleeding-risk patients to reduce recurrent heart attack risk. For patients with high bleeding risks, alternative durations and therapies are outlined.
- Percutaneous Coronary Intervention (PCI): The wrist approach is now preferred over the groin approach for heart procedures in emergency patients to reduce the risk of bleeding and complications. In these PCI procedures, cardiologists treat the heart by entering a catheter through the wrist rather than through the groin. Additionally, intravascular imaging has been upgraded to a Class 1, Level A recommendation to enhance procedural precision.
- Cardiogenic Shock Management: Affecting approximately 10 percent of ACS patients, cardiogenic shock occurs when the heart is too weak to pump enough blood to the body, leading to an early mortality rate of up to 50 percent. The guidelines emphasize prompt restoration of blood flow and introduce new evidence on the effectiveness of an adjunct therapy called microaxial flow pump use in select patients.
Prioritizing Secondary Prevention
Post-ACS care is crucial for preventing complications and recurrence. The guidelines recommend these practices:
- Lipid Management: A fasting lipid panel four to eight weeks post-initiation or modification of lipid-lowering therapy to optimize treatment.
- LDL Cholesterol Control: For patients on maximally tolerated statins with LDL ≥70 mg/dL, adding nonstatin agents such as ezetimibe or PCSK9 inhibitors is strongly recommended.
- Cardiac Rehabilitation: Referral to outpatient cardiac rehab before discharge is advised to improve survival, reduce heart attack recurrence, and enhance quality of life.
“It’s been quite a while since the last document, and the field moves quickly,” noted Dr. Rao. “There are multiple randomized trials now influencing clinical practice that clinicians are either already incorporating into their practice or are looking to an updated guidelines document to understand how to incorporate those things into their clinical practice.”
Dr. Rao will talk about these new ACS guidelines in a in Chicago on Sunday, March 30, from 11:30AM to 12:30PM CT.
The guideline was written in collaboration and endorsed by multiple professional societies, including the American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the Society for Cardiovascular Angiography and Interventions (SCAI).
Media Inquiries
Katie Ullman
Phone: 646-483-3984
Kathryn.Ullman@NYULangone.org
