Acute coronary syndrome

Also known as: ACS · heart attack · MI · myocardial infarction · NSTEMI · STEMI · unstable angina

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United StatesACC/AHA

Current

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

ACC/AHA/ACEP/NAEMSP/SCAI · 2025

The current US ACS guideline. It combines STEMI and NSTE-ACS into a single document, replacing the separate 2013 STEMI and 2014 NSTE-ACS guidelines and the 2015 PCI focused update.

Covers the full ACS spectrum (STEMI and NSTEMI) in one document. source
Prefers radial over femoral access for PCI to reduce bleeding. source
Recommends adding a nonstatin lipid-lowering agent to maximally tolerated statin therapy after ACS for more aggressive LDL-C lowering. source

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EuropeESC

Current

2023 ESC Guidelines for the management of acute coronary syndromes

ESC · 2023

The current European ACS guideline. For the first time it presents recommendations across the whole ACS spectrum in a single document, replacing separate STEMI and NSTE-ACS guidelines.

Unifies STEMI and NSTE-ACS management into one guideline. source
Frames care around the acute, in-hospital, and long-term phases of ACS. source

Verify against original ↗

US vs EU key differences

Both bodies have now consolidated STEMI and NSTE-ACS into a single ACS document — the ESC in 2023, the US in 2025. source
The US 2025 guideline is the more recent of the two and adds explicit guidance on nonstatin add-on lipid therapy after ACS. source

What changed recently

US2013 STEMI / 2014 NSTEMI guidelines → 20252025-02-27
The 2025 guideline merges the separate 2013 STEMI and 2014 NSTEMI documents (plus the 2015 primary-PCI focused update) into a single guideline spanning unstable angina, NSTE-ACS and STEMI. New positions include a recommendation to use intracoronary imaging to guide PCI, a weak (Class 2b) option for bivalirudin in NSTE-ACS to limit bleeding, and advice against fondaparinux as the sole anticoagulant during PCI.
source ↗
EU2017 STEMI / 2020 NSTE-ACS guidelines → 20232023-08-25
For the first time the ESC covers the entire ACS spectrum in a single document, replacing the separate 2017 STEMI and 2020 NSTE-ACS guidelines. It rebuilds guidance on initial diagnosis and risk stratification, antithrombotic therapy, and the timing of invasive assessment and revascularisation.
source ↗

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