Work

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

Year: 2026

Type: article

Abstract: 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 P2Y 12 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 P2Y 12 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 .

Source: The Medical Journal of Australia

DOI: 10.5694/mja2.70127