Current recommendations for the assessment and treatment of acute coronary syndromes (ACS) focus on a multifaceted, evidence-based approach that builds on prior guidelines while integrating advancements in pharmacotherapy and diagnostic techniques. ACS encompasses conditions such as unstable angina and myocardial infarction (both ST-elevation and non-ST-elevation), necessitating prompt identification and management to optimize patient outcomes.
Initial assessment should prioritize a comprehensive clinical evaluation, utilizing clinical decision tools such as the HEART score (https://www.heartscore.nl/), which aids in stratifying risk among patients presenting with chest pain (Wang et al., 2024)Babu et al., 2023). The integration of these tools, alongside traditional metrics such as electrocardiogram (ECG) findings and troponin levels, forms the cornerstone of early risk stratification, helping to rule in or rule out ACS (Damani & Roongsritong, 2025). The use of computed tomography coronary angiography is also highlighted as a valuable tool in selected cases to assist in diagnosis (Wang et al., 2024).
Pharmacological management remains pivotal in the treatment of ACS, particularly regarding antiplatelet therapy. Current guidelines recommend dual antiplatelet therapy (DAPT) combining aspirin with a P2Y12 inhibitor, such as clopidogrel, for at least 12 months following percutaneous coronary intervention (PCI) to reduce the risk of recurrent thrombotic events (Cheng et al., 2025). Emerging evidence suggests modifications in antiplatelet regimens may be warranted depending on individual patient characteristics and the presence of specific complications such as spontaneous coronary artery dissection (SCAD) (Park et al., 2024; Ilić et al., 2023).
A particular emphasis has been placed on tailoring treatment strategies according to the demographic and clinical profile of patients, particularly older adults, who may present unique challenges due to comorbidities and frailty (Damluji et al., 2023). The recommendations advocate for an individual approach to therapy, factoring in the complexities of polypharmacy and the need for careful monitoring of potential adverse effects (Damluji et al., 2023).
Furthermore, the guidelines encourage healthcare providers to optimize adherence to evidence-based therapies through comprehensive patient education and awareness of secondary prevention measures. These include lifestyle modifications, the management of comorbid conditions, and engagement in cardiac rehabilitation programs, which have been shown to improve clinical outcomes significantly (Gebremichael et al., 2024).
As part of evolving care strategies, attention to socioeconomic factors and barriers to accessing care is increasingly recognized as crucial in the management of ACS. The American Heart Association recommends that healthcare systems work to address disparities in treatment and outcomes across different patient populations (Sarrafzadegan et al., 2024).
In conclusion, current recommendations emphasize a holistic and personalized approach to the assessment and management of ACS, incorporating the latest evidence in pharmacotherapy, technology, and patient-centered care practices to enhance outcomes for individuals at risk of or suffering from acute coronary syndromes.
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