Historical collection · First published Feb 27, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articles2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Summary
The updated ACS guideline integrates STEMI and NSTE-ACS care. It recommends emergency culprit-vessel revascularization in cardiogenic shock, with no routine concurrent PCI of other arteries. For ACS with anemia without active bleeding, transfusion to maintain hemoglobin around 10 g/dL may be reasonable; this is a weak recommendation, not a universal transfusion mandate.
Why it matters
Review ED-to-cath-lab pathways and avoid applying a generic restrictive transfusion threshold reflexively to every ACS patient.
Study at a glance
- Design
- Guideline
- Population
- Adults with ACS, including STEMI, NSTE-ACS and infarction-associated cardiogenic shock.
- Sample size
- Not applicable
- Intervention
- Updated acute assessment, antithrombotic and revascularization pathways.
- Comparator
- Prior separate STEMI/NSTE-ACS guidance.
- Primary endpoint
- Clinical recommendations for acute ACS care.
Main findings
- Aspirin plus an oral P2Y12 inhibitor remains the default DAPT strategy for at least 12 months when bleeding risk is not high.
- Selected microaxial-pump use in AMI-related shock may reduce mortality but increases bleeding, limb ischemia and renal complications.
Limitations
This summary is based on the official AHA synopsis and a retrieved recommendation excerpt, not full guideline appraisal. Bleeding risk and procedural plans affect antithrombotic decisions.
Recommendation strength
Transfusion to achieve hemoglobin ≥10 g/dL: Class 2b, Level B-R. Other recommendations have their own grades.
Read the primary source
Full text: Official society summary available.
Original sourceDOI: 10.1161/CIR.0000000000001309
PMID: 40014670
Material reviewed: official society summary.
Source retrieved Oct 27, 2026. Historical backfill. Official AHA Top Things to Know and publisher transfusion recommendation excerpt reviewed; full guideline not reviewed. First online February 27, 2025 confirmed by primary PubMed metadata. Transfusion grade verified in https://www.jacc.org/doi/10.1016/j.jacc.2024.11.009 Independent cross-review clarified that the society synopsis transfusion suggestion concerns patients without active bleeding. A June 2025 correction (10.1161/CIR.0000000000001346) was identified; complete correction text was not reviewed, so claims here remain limited to the current official society summary.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.