DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 
The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline provides updated evidence-based recommendations for managing acute coronary syndromes, focusing primarily on type 1 acute myocardial infarction (NSTEMI and STEMI). This collaborative guideline addresses pharmacologic care, procedural approaches, cardiogenic shock management, and secondary prevention strategies.
Key Clinical Considerations
- DAPT with aspirin and P2Y12 inhibitor is indicated for ≥12 months in ACS patients without high bleeding risk, while alternative strategies are recommended for those with elevated bleeding risk.
- High-intensity statin therapy is recommended for all ACS patients, with addition of nonstatin agents (ezetimibe, PCSK9 inhibitors, inclisiran, or bempedoic acid) for those with LDL-C ≥70 mg/dL despite maximum statin therapy.
- Radial approach is preferred over femoral for PCI to reduce bleeding, vascular complications, and mortality, with intravascular imaging during PCI now a Class 1 recommendation.
- Complete revascularization strategy is recommended for both STEMI and NSTEMI patients, with revascularization method selection based on coronary disease complexity and comorbidities.
- Microaxial flow pump use is now recommended for select patients with MI-related cardiogenic shock, with emphasis on careful vascular access management and support weaning.
Clinical Practice Impact
- Implementation requires updating catheterization lab protocols to prioritize radial access and intravascular imaging during PCI.
- Pharmacy protocols should be revised for extended DAPT regimens and lipid management pathways.
- Establish cardiogenic shock teams with clear criteria for mechanical support device utilization.
- Develop comprehensive discharge planning with cardiac rehabilitation referrals and systematic 4-8 week post-discharge lipid assessment
- Consider resource allocation for increased intravascular imaging equipment and training.
More on Acute Coronary Syndrome (ACS)