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Review
. 2024 Mar 25;13(7):1885.
doi: 10.3390/jcm13071885.

The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome

Roberto Licordari  1 , Francesco Costa  1 , Victoria Garcia-Ruiz  2 , Mamas A Mamas  3 , Guillaume Marquis-Gravel  4 , Jose M de la Torre Hernandez  5 , Juan Jose Gomez Doblas  6 , Manuel Jimenez-Navarro  6 , Jorge Rodriguez-Capitan  6 , Cristobal Urbano-Carrillo  7 , Luis Ortega-Paz  8 , Raffaele Piccolo  9 , Antonio Giovanni Versace  10 , Gianluca Di Bella  11 , Giuseppe Andò  11 , Dominick J Angiolillo  8 , Marco Valgimigli  12 , Antonio Micari  1
Affiliations
Review

The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome

Roberto Licordari et al. J Clin Med. .

Abstract

Acute coronary syndromes (ACS), encompassing conditions like ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndromes (NSTE-ACS), represent a significant challenge in cardiovascular care due to their complex pathophysiology and substantial impact on morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines for ACS management introduce several updates in key areas such as invasive treatment timing in NSTE-ACS, pre-treatment strategies, approaches to multivessel disease, and the use of imaging modalities including computed tomography (CT) coronary angiography, magnetic resonance imaging (MRI), and intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). They also address a modulation of antiplatelet therapy, taking into consideration different patient risk profiles, and introduce new recommendations for low-dose colchicine. These guidelines provide important evidence-based updates in practice, reflecting an evolution in the understanding and management of ACS, yet some potentially missed opportunities for more personalized care and technology adoption are discussed.

Keywords: acute coronary syndrome; clinical practice guidelines; colchicine; dual antiplatelet therapy; intravascular imaging; polypill.

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Conflict of interest statement

D.J.A. declares that he has received consulting fees or honoraria from Abbott, Amgen, Astra-Zeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Daiichi-Sankyo, Eli Lilly, Faraday, Haemonetics, Janssen, Merck, Novartis, Novo Nordisk, PhaseBio, PLx Pharma, Pfizer, Sanofi and Vectura; Angiolillo also declares that his institution has received research grants from Amgen, AstraZeneca, Bayer, Biosensors, Celo-Nova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Faraday, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, and the Scott R. MacKenzie Foundation.

Figures

Figure 1
Figure 1
Summary of possible achievements and missed opportunities of the 2023 ESC guidelines for the management of Acute Coronary Syndromes.
See this image and copyright information in PMC

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