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2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Circulation
April 2025
ACC/AHA Joint Committee on Performance Measures representative.
Aim: The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."
Methods: A comprehensive literature search was conducted from July 2023 to April 2024.
Article Synopsis
- The 2025 guideline aims to integrate the latest research and evidence since previous guidelines for managing acute coronary syndromes, effectively replacing older guidelines.
- A thorough literature search was performed from mid-2023 to early 2024, focusing on clinical studies and reviews involving human participants published in English across various medical databases.
- The updated guidelines include revised recommendations based on new evidence, as well as entirely new recommendations where warranted.
Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory.
ASEAN Heart J
January 2014
UCLA Medical Center, Los Angeles, CA USA.
The goal of anticoagulation during percutaneous coronary intervention (PCI) is the primary and secondary prevention of thrombotic and significant bleeding events that increase cardiovascular morbidity and mortality. Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories. The ACC/AHA/SCAI PCI guidelines recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used.
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