The following are key points to remember from the 2023 European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes (ACS):

1. The new ESC ACS guidelines combine previously separate guidelines for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). While there are no dramatic changes in the core components of the management of ACS, this comprehensive repertoire of recommendations addresses nuances in various aspects of the management of ACS.
2. Glucose-Lowering Treatment: The only Class I recommendation with a level of evidence (LOE) A highlights the importance of tailoring glucose-lowering treatment according to co-morbidities—a recommendation that follows the growing evidence supporting cardiovascular benefits of specific therapies.
3. Strong emphasis on dual antiplatelet therapy (DAPT): Class I recommendation for resuming DAPT for ≥12 months after coronary artery bypass grafting (LOE C).
4. Neurological Assessment: Class I guidance advises neurological prognosis evaluation 72 hours post-admission in comatose survivors of cardiac arrest (LOE C).
5. Invasive Strategies: Class I and IIa recommendations prioritize percutaneous coronary intervention based on angiographic severity and intravascular imaging guidance (LOEs B, A).
6. Device Implantation: Class I guideline recommends a permanent pacemaker for unresolved high-degree AV block post-MI after a 5-day waiting period (LOE C).
7. Cancer and ACS: Class I and IIa recommendations focus on individualized interventional and pharmacological treatments for cancer patients with ACS based on their prognosis and bleeding risk (LOEs B, C).
8. Long-Term Management: Class I and IIb guidelines recommend intensifying lipid-lowering therapy during the index ACS hospitalization and consider low-dose colchicine for residual risk (LOEs C, A).
9. Patient-Centered Care: Class I and IIa recommendations emphasize patient-centered care and inclusion of patients in decision-making (LOEs B, C).
10. Antiplatelet Therapy Caution: Class III guidelines caution against de-escalation of antiplatelet therapy in the first 30 days post-ACS and in cancer patients with low platelet counts (LOEs B, C).
11. Antiplatelet Therapy Caution: Class III guidelines caution against de-escalation of antiplatelet therapy in the first 30 days post-ACS (LOE B).

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD, Lipid Metabolism, Interventions and ACS, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Acute Coronary Syndrome, Atrioventricular Block, Coronary Angiography, Coronary Artery Bypass, Colchicine, ESC Congress, ESC23, Heart Arrest, Glucose, Lipids, Myocardial Infarction, Neoplasms, Non-ST Elevated Myocardial Infarction, Pacemaker, Artificial, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Secondary Prevention, ST Elevation Myocardial Infarction

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