Post-MI care
Also known as: cardiac rehabilitation · secondary prevention after myocardial infarction
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2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes
ACC/AHA/ACEP/NAEMSP/SCAI · 2025
This multi-society US guideline covers the full spectrum of acute coronary syndromes, from prehospital and emergency presentation through revascularisation and the period after discharge. For clinicians looking for post-myocardial-infarction care, the relevant material sits in the guideline's discharge-planning and long-term secondary-prevention sections, which address lipid-lowering therapy, antithrombotic strategy, and cardiac rehabilitation referral. Metadata record only — consult the guideline itself for recommendations.
- Issued in 2025 by the ACC/AHA Joint Committee on Clinical Practice Guidelines together with ACEP, NAEMSP and SCAI. source
- Scope spans diagnosis, acute treatment and decision-making across multiple care settings, including care after hospital discharge. source
- Secondary-prevention content includes lipid management follow-up and referral to cardiac rehabilitation, including home-based options. source
2023 ESC Guidelines for the management of acute coronary syndromes
European Society of Cardiology (ESC) · 2023
The ESC's 2023 document was the first to bring the whole acute coronary syndrome spectrum — unstable angina through all myocardial infarction types — into a single guideline. Alongside acute management it explicitly addresses long-term management after the initial hospitalisation, which is the section clinicians will want for post-MI follow-up and secondary prevention. Metadata record only; no clinical recommendations are reproduced here.
- Published by the ESC on 25 August 2023 and consolidates the earlier separate STEMI (2017) and NSTE-ACS (2020) guidelines. source
- Includes a dedicated section on long-term management following the initial hospitalisation period. source
- Covers the pathway from initial diagnosis and risk stratification through to extended post-discharge care. source
US vs EU key differences
- P2Y12 inhibitor loading is graded very differently: the 2025 US ACS guideline keeps early P2Y12 loading as a strong Class 1 recommendation, while the 2023 ESC guideline downgraded routine pretreatment to a weak Class IIb recommendation after trials such as ATLANTIC showed no mortality benefit. source
- Lipid escalation after ACS is numeric in the US document: a non-statin agent is added when LDL-C is at or above 70 mg/dL on maximally tolerated statin, and further intensification is considered in the 55 to under 70 mg/dL band. source
- The ESC takes a staged lipid approach — high-intensity statin first, with PCSK9 inhibitor consideration at reassessment roughly a month after the event — rather than the US guideline's immediate threshold-driven escalation. source
- Document architecture differs: the 2023 ESC text is the first European guideline to cover the entire ACS spectrum (STEMI and NSTE-ACS) in a single document, replacing the separate 2017 and 2020 guidelines; the equivalent combined US document did not appear until 2025. source
What changed recently
- US2013 STEMI / 2014 NSTEMI guidelines → 20252025-02-27
The 2025 guideline consolidates the 2013 STEMI, 2014 NSTEMI and 2015 primary-PCI focused update into one document covering the whole ACS spectrum, and refreshes post-infarction antithrombotic and revascularisation guidance, including intracoronary imaging to guide PCI and revised anticoagulant choices.
- EU2017 STEMI / 2020 NSTE-ACS guidelines → 20232023-08-25
The 2023 ESC guideline supersedes the separate 2017 STEMI and 2020 NSTE-ACS documents and treats long-term management after hospital discharge as an integral part of ACS care, with updated antithrombotic and secondary-prevention guidance across the whole spectrum.
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