National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025.

Abstract

INTRODUCTION: The Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025 establishes a new clinical standard for the diagnosis and management of acute coronary syndromes (ACS) in Australia. The new guideline replaces the 2016 guideline, representing the first major update in nearly a decade.

MAIN RECOMMENDATIONS: The new guideline features critical new information, including: (1) new terminology and revised definition of myocardial infarction; (2) electrocardiogram (ECG) patterns of acute coronary occlusion myocardial infarction (ACOMI), beyond ST-segment elevation; (3) use of clinical decision pathways incorporating high-sensitivity cardiac troponin (hs-cTn) assays for more efficient risk assessment; (4) stronger emphasis on the optimal timing of primary percutaneous coronary intervention in people with ST-segment elevation myocardial infarction (STEMI); (5) use of intravascular imaging-guided percutaneous coronary intervention in people with non-ST-segment elevation acute coronary syndromes (NSTEACS); (6) treatment guidance for specific groups, including those with cardiogenic shock, multivessel disease or spontaneous coronary artery dissection; (7) timing of platelet P2Y12 inhibitor administration in STEMI and NSTEACS; (8) more detailed advice on post-discharge care, including cardiac rehabilitation and secondary prevention programs, medicine adherence strategies, vaccinations and screening for mental health conditions; (9) treatment algorithms to enable more tailored prescribing of antiplatelet and anticoagulation therapies; (10) new recommended treatment target for low-density lipoprotein cholesterol (LDL-C); and (11) new recommendations on select medicines including PCSK9 inhibitors, β-blockers and angiotensin receptor-neprilysin inhibitors.

CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE: The new guideline introduces key practice changes including broader recognition of ECG patterns of ACOMI, integration of hs-cTn testing into clinical decisions pathways and selective use of intravascular imaging in NSTEACS. Updated P2Y12 inhibitor timing, stricter LDL-C targets and PCSK9 inhibitor use support more tailored and evidence-based care in the secondary prevention of ACS. The full guideline is available at www.heartfoundation.org.au/for-professionals/acs-guideline.