2023 ESC Guidelines for the management of acute coronary syndromes

Byrne, Robert A; Rossello, Xavier; Coughlan, J J; Barbato, Emanuele; Berry, Colin; Chieffo, Alaide; Claeys, Marc J; Dan, Gheorghe-Andrei; Dweck, Marc R; Galbraith, Mary; Gilard, Martine; Hinterbuchner, Lynne; Jankowska, Ewa A; Jüni, Peter; Kimura, Takeshi; Kunadian, Vijay; Leosdottir, Margret; Lorusso, Roberto; Pedretti, Roberto F E; Rigopoulos, Angelos G; Rubini Gimenez, Maria; Thiele, Holger; Vranckx, Pascal; Wassmann, Sven; Wenger, Nanette Kass; Ibanez, Borja; ,; Halvorsen, Sigrun; James, Stefan; Abdelhamid, Magdy; Aboyans, Victor; Marsan, Nina Ajmone; Antoniou, Sotiris; Asteggiano, Riccardo; Bäck, Maria; Capodanno, Davide; Casado-Arroyo, Ruben; Cassese, Salvatore; Čelutkienė, Jelena; Cikes, Maja; Collet, Jean-Philippe; Ducrocq, Gregory; Falk, Volkmar; Fauchier, Laurent; Geisler, Tobias; Gorog, Diana A; Holmvang, Lene; Jaarsma, Tiny; Jones, Hywel Wynne; Køber, Lars; Koskinas, Konstantinos C; Kotecha, Dipak; Krychtiuk, Konstantin A; Landmesser, Ulf; Lazaros, George; Lewis, Basil S; Lindahl, Bertil; Linhart, Ales; Løchen, Maja-Lisa; Mamas, Mamas A; McEvoy, John William; Mihaylova, Borislava; Mindham, Richard; Mueller, Christian; Neubeck, Lis; Niebauer, Josef; Nielsen, Jens Cosedis; Niessner, Alexander; Paradies, Valeria; Pasquet, Agnes A; Petersen, Steffen E; Prescott, Eva; Rakisheva, Amina; Rocca, Bianca; Rosano, Giuseppe M C; Sade, Leyla Elif; Schiele, François; Siller-Matula, Jolanta M; Sticherling, Christian; Storey, Robert F; Thielmann, Matthias; Vrints, Christiaan; Windecker, Stephan; Wiseth, Rune; Witkowski, Adam; El Amine Bouzid, Mohammed; Hayrapetyan, Hamlet; Metzler, Bernhard; Lancellotti, Patrizio; Bajrić, Mugdim; Karamfiloff, Kiril; Mitsis, Andreas; Ostadal, Petr; Sørensen, Rikke; Elwasify, Tamer; Marandi, Toomas; Ryödi, Essi; Collet, Jean-Philippe; Chukhrukidze, Archil; Mehilli, Julinda; Davlouros, Periklis; Becker, Dávid; Guðmundsdóttir, Ingibjörg Jóna; Crowley, James; Abramowitz, Yigal; Indolfi, Ciro; Sakhov, Orazbek; Elezi, Shpend; Beishenkulov, Medet; Erglis, Andrejs; Moussallem, Nicolas; Benlamin, Hisham; Dobilienė, Olivija; Degrell, Philippe; Balbi, Matthew Mercieca; Grosu, Aurel; Lakhal, Zouhair; ten Berg, Jurriën; Pejkov, Hristo; Angel, Kristin; Witkowski, Adam; De Sousa Almeida, Manuel; Chioncel, Ovidiu; Bertelli, Luca; Stojkovic, Sinisa; Studenčan, Martin; Radšel, Peter; Ferreiro, Jose Luis; Ravn-Fischer, Annica; Räber, Lorenz; Marjeh, Mohammed Yassin Bani; Hassine, Majed; Yildirir, Aylin; Parkhomenko, Alexander; Banning, Adrian Paul; Prescott, Eva; James, Stefan; Arbelo, Elena; Baigent, Colin; Borger, Michael A; Buccheri, Sergio; Ibanez, Borja; Køber, Lars; Koskinas, Konstantinos C; McEvoy, John William; Mihaylova, Borislava; Mindham, Richard; Neubeck, Lis; Nielsen, Jens Cosedis; Pasquet, Agnes A; Rakisheva, Amina; Rocca, Bianca; Rossello, Xavier; Vaartjes, Ilonca; Vrints, Christiaan; Witkowski, Adam; Zeppenfeld, Katja

doi:10.1093/ehjacc/zuad107

Cited by 49 publications

(28 citation statements)

References 904 publications

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“…Although aortocoronary bypass surgery per itself is a procedure with an elevated risk for blood transfusions as compared to many other routine procedures, no inter-BG differences were found in non-emergency patients. In emergency CABG, which generally has a higher risk for blood loss as patients routinely enter the operation loaded with double platelet inhibitors and therapeutic doses of heparin in compliance with the current guidelines for acute myocardial infarction [ 22 , 23 ], BG AB was associated with less transfusions in this study. Although a trend towards more frequent perioperative transfusions could be seen in BG O patients, the difference did not reach significance.…”

Section: Discussionmentioning

confidence: 89%

“…Current surgical guidelines recommend double platelet inhibition just for postoperative CABG patients with preoperative acute coronary syndrome and optional in patients with a higher ischemic risk due to coronary endarterectomy or off-pump surgery [ 29 ]. Accordingly the very recent guidelines of the European Society of Cardiology recommend that patients with acute coronary syndromes undergoing cardiac revascularisation should begin or resume double platelet inhibition therapy after surgery for at least 12 months [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery

Masseli,

Veseli,

Pfohl

et al. 2024

J Thromb Thrombolysis

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Patient blood group (BG) is predictive for von-Willebrand-factor (VWF) and Factor VIII variation. The clinical impact of this ABO-effect on blood loss, cardiovascular complications and outcome has been described for several patient cohorts. The aim of this study was to investigate the impact of patient BG on blood loss and outcome after coronary artery bypass surgery (CABG). Patient records, intraoperative data and perioperative transfusion records of 5713 patients receiving an on-pump CABG procedure between 05/2004 and 12/2018 were analyzed. A logistic regression model for death due to perioperative myocardial ischaemia (PMI) was developed from initially 24 variables by using an univariate and multivariate selection process. BG AB patients required less blood transfusions as compared to the other blood groups, especially in case of emergency operations. However, BG AB patients also had a higher mortality which was due to secondary cardiovascular complications. The impact of blood type on the rate of cardiovascular mortality was confirmed in the logistic regression model. BG AB patients have a worse outcome after CABG surgery due to an increased incidence of fatal cardiovascular complications. As perioperative myocardial ischemia due to graft occlusion appears to be the most likely explanation, stricter anticoagulation for BG AB patients should be discussed.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery

Masseli,

Veseli,

Pfohl

et al. 2024

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…LV dysfunction is a key prognostic factor in patients presenting ACS. Current guidelines recommend routine echocardiography before hospital discharge to assess LV, right ventricle and valvular function that may influence outcomes in ACS survivors [31]. Several studies evaluated the usefulness of MW in patients with ACS.…”

Section: Acute Coronary Syndromesmentioning

confidence: 99%

Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus

Frișan,

Mornoș,

Lazăr

et al. 2024

Medicina

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Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the assessment of myocardial contractility. The accurate evaluation of LV function is crucial for identifying patients who are at high risk or may have worse outcomes. Myocardial work (MW) is emerging as an alternative tool for the evaluation of LV systolic function, providing additional information on cardiac performance when compared to conventional parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) because it incorporates deformation and load into its analysis. The potential of MW in various conditions is promising and it has gained increased attention. However, larger studies are necessary to further investigate its role and application before giving an answer to the question of whether it can have widespread implementation into clinical practice. The aim of this review is to summarize the actual knowledge of MW for the analysis of LV dysfunction caused by myocardial ischemia and hyperglycemia.

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“…One month of DAPT might be considered for high-bleeding-risk (HBR) patients, followed by aspirin or P2Y12 inhibitor. Three to six months of DAPT should be applicable for event-free patients who are also not at high ischemic risk, preferably followed by a P2Y12 inhibitor [ 3 , 4 ]. However, due to constantly evolving stent technology, intravascular imaging optimization of stent implantation, and the introduction of new P2Y12 inhibitors, optimal DAPT duration remains a topic of intense discussion.…”

Section: Introductionmentioning

confidence: 99%

Importance of Short-Term Neointimal Coverage of Drug-Eluting Stents in the Duration of Dual Antiplatelet Therapy

Fluder-Wlodarczyk,

Pawłowski,

Chuchra

et al. 2024

JCM

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Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation, but optimal DAPT duration remains a topic of intense discussion. The shorter regimen of DAPT might be especially beneficial for high-bleeding-risk (HBR) patients. Novel stent platforms have been designed with innovations that should facilitate vessel healing following stent implantation and enable short DAPT. This review aimed to summarize evidence of the neointimal coverage of short-term stents and their implications for DAPT duration. Results from histological and optical coherence tomography (OCT) studies confirm the significant role of uncovered struts after the implantation of a stent in patients presenting with late stent thrombosis. Several studies have shown favorable vessel healing at one month (with 83.2% of covered struts, on average) and three months following stent implantation (with 93.3% of covered struts, on average). Solely HBR patient trials have proven that one month of DAPT can be applicable and safe in this population. Three-month DAPT was tested in a more diverse population and remains effective and safe in comparison to a longer DAPT regimen. That evidence proves that short-term DAPT might be applicable, especially for HBR patients.

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2023 ESC Guidelines for the management of acute coronary syndromes

Cited by 49 publications

References 904 publications

Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery

Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery

Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus

Importance of Short-Term Neointimal Coverage of Drug-Eluting Stents in the Duration of Dual Antiplatelet Therapy

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