279. The Rounds Table - 2025 ACC/AHA Clinical Practice Guidelines for Acute Coronary Syndrome

The 2025 Acute Coronary Syndrome (ACS) guidelines emphasize evidence-based management strategies, prioritizing potent antiplatelet therapies like ticagrelor or prasugrel over clopidogrel for patients undergoing PCI. Effective bleeding risk mitigation involves the judicious use of proton pump inhibitors and transitioning to monotherapy when appropriate. High-intensity statin therapy remains foundational, with clear targets for LDL reduction and the potential addition of ezetimibe or PCSK9 inhibitors if thresholds are not met. For STEMI patients, complete revascularization is recommended, while NSTEMI management relies on risk stratification using tools like the TIMI score to guide invasive procedures. Furthermore, clinical evidence supports a higher hemoglobin transfusion threshold of 100 g/L for ACS patients with anemia, challenging previous restrictive practices. These updates integrate secondary prevention, including mandatory cardiac rehabilitation, to improve long-term cardiovascular outcomes and patient quality of life.