SPC365

Acute Coronary Syndrome: what has changed 2 years after new ESC guidelines?

Session: Sessão de Posters 46 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker: Isabel Maria Martins Moreira

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Isabel Martins Moreira; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; Matilde Pipa; Pedro Rocha Carvalho; Pedro Mateus; Inês Silveira; Ilídio Moreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction:</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"> The 2023 European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes (ACS) introduced major updates, including refined invasive strategy in high-risk patients, a more selective use of pretreatment with P2Y12 inhibitors, and a stronger recommendation for complete revascularization in STEMI. These changes aimed to improve outcomes through safer and more individualized care.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"> To assess the impact of the implementation of the 2023 ESC ACS guidelines on clinical practice and patient outcomes in a real-world setting.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"> Single-centre retrospective study including patients hospitalized with ACS and enrolled in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and July 2025. Patients were divided into two groups: before (Group A) and after August 2023 (Group B). Baseline characteristics, management strategies, and outcomes were compared.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results:</span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> A total of 1455 patients were included (73.3% male, mean age of 67.0&plusmn;12.8 years); 1154 (79.3%) in Group A and 301 (20.7%) in Group B. Patients in group A were older (67.3&plusmn;12.7 vs 65.6&plusmn;12.9 years, p=0.043), less often smokers (</span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">23.2% vs 30.2%, p=0.012) and had fewer previous percutaneous coronary interventions (PCI) (10.8% vs 15.6%, p=0.022). </span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">After guideline implementation, STEMI admissions increased (56.8% vs 45.4%, p&lt;0.001). T</span></span><span style="font-family:&quot;Calibri&quot;,sans-serif">here was a higher rate of coronary angiography </span><span style="font-family:&quot;Calibri&quot;,sans-serif">(</span><span style="font-family:&quot;Calibri&quot;,sans-serif">99.7% vs 96.6%, p=0.004), PCI (85.0% vs 76.8%, p=0.002) and staged PCI (28.9% vs 19%, p=0.002)</span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">, with greater use of radial access (94% vs 70.9%, p&lt;0.001).</span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"> In NSTEMI patients, the time to coronary angiography was reduced (18.7 vs 36.8 hours, p&lt;0.001). In STEMI patients, fibrinolysis decreased (2% vs 11.6%, p&lt;0.001) and pre-catheterization P2Y12 loading was less frequent (59.6% vs 85.1%, p&lt;0.001). </span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Regarding medical therapy, use of potent P2Y12 inhibitors (prasugrel/ticagrelor) and additional lipid-lowering agents increased, while clopidogrel, nitrates, and beta-blockers were less prescribed. In-hospital complications decreased, including heart failure (14.0% vs 21.0%, p=0.006), cardiogenic shock (1.3% vs 4.9%, p=0.006), and mechanical complications (0% vs 1%, p=0.035), with shorter hospital stay (5&plusmn;3 vs 6&plusmn;4 days, p=0.003). In-hospital mortality remained similar (1.0% vs 1.8%, p=0.318). Referral for cardiac rehabilitation increased significantly (52.7% vs 16.9%, p&lt;0.001).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusion</span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">: Implementation of the 2023 ESC ACS guidelines was associated with significant changes in clinical management, particularly in invasive strategy and antiplatelet therapy, leading to fewer in-hospital complications and shorter admissions. These results support their positive impact on real-world clinical practice.</span></span></span></span></p>