2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes

The 2025 guideline merges the separate US STEMI (2013) and NSTE-ACS (2014) documents into a single ACS pathway — the same consolidation the ESC made in 2023. Two divergences from the ESC are worth knowing. Lipids: the US committee works with an LDL-C threshold rather than a target, adding a non-statin agent when LDL-C stays ≥70 mg/dL on maximally tolerated statin (and calling further intensification reasonable at 55–<70 mg/dL), where the ESC 2023 ACS guideline commits to a target of <55 mg/dL plus ≥50% reduction. Cardiogenic shock: with DanGer Shock in hand the microaxial flow pump becomes Class 2a in STEMI-related shock while the intra-aortic balloon pump and routine VA-ECMO are pushed down to Class 3 (no benefit) — the ESC document predates that trial. The register's ACS trials are grouped by theme below.

This guideline cites 19 of the 199 landmark trials in our Cardiology register.

Source

Rao SV, O'Donoghue ML, et al. Circulation. 2025;151(13):e771–e862.

DOI

10.1161/CIR.0000000000001309