p.3 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 April 1, 2025 e773

8.2. MCS in Patients With ACS and Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . e816 9.	 ACS Complications. . . . . . . . . . . . . . . . . . . . . . . . . . e818 9.1. Mechanical Complications. . . . . . . . . . . . . . e818 9.2. Electrical Complications and Prevention of Sudden Cardiac Death After ACS. . . . . . . . . . . . . . . . . . . . . . e819 9.3. Pericarditis Management After MI. . . . . . e820 9.4. Management of LV Thrombus After MI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e821 10.	 In-hospital Issues in the Management of

ACS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e821 10.1.	 Cardiac Intensive Care Unit. . . . . . . . . . . . e821 10.2.	 Management of Anemia in ACS. . . . . . . . e822 10.3.	 Telemetry and Length of Stay. . . . . . . . . . . e822 10.4.	 Noninvasive Diagnostic Testing Prior to Hospital Discharge. . . . . . . . . . . . . e823 10.5.	 Discharge Planning. . . . . . . . . . . . . . . . . . . . e823

10.5.1 Patient Education. . . . . . . . . . . . . . e823 10.5.2.	Postdischarge Follow-Up

and Systems of Care Coordination. . . . . . . . . . . . . . . . . . . e824 10.5.3.	Cardiac Rehabilitation. . . . . . . . . . e824 11.	 Discharge: Long-Term Management and

Secondary Prevention. . . . . . . . . . . . . . . . . . . . . . . . e826 11.1.	 DAPT Strategies in the First

12 Months Postdischarge. . . . . . . . . . . . . . e826 11.1.1.	Antiplatelet Therapy in Patients on Anticoagulation Postdischarge. . . . . . . . . . . . . . . . . . e829 11.2.	 Reassessment of Lipid Levels Postdischarge. . . . . . . . . . . . . . . . . . . . . . . . . e830 11.3.	 SGLT-2 Inhibitors and GLP-1 Receptor Agonists. . . . . . . . . . . . . . . . . . . . . e831 11.4.	 Use of Chronic Colchicine. . . . . . . . . . . . . . e831 11.5.	 Immunization. . . . . . . . . . . . . . . . . . . . . . . . . . e832 12.	 Evidence Gaps and Future Directions. . . . . . . . . e832 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e834 Appendix 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e857 Author Relationships With Industry and Other Entities��������������������������������������������������������������e857 Appendix 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e862

Reviewer Relationships With Industry and Other Entities��������������������������������������������������������������e862

TOP TAKE-HOME MESSAGES

1 Dual antiplatelet therapy is recommended for

patients with acute coronary syndromes (ACS). Ticagrelor or prasugrel is recommended in preference to clopidogrel in patients with ACS who are undergoing percutaneous coronary intervention (PCI). In patients with non–ST-segment elevation ACS who are scheduled for an invasive strategy with timing of angiography to be >24 hours, upstream treatment with clopidogrel or ticagrelor may be considered to reduce major adverse cardiovascular events. 2.	 Dual antiplatelet therapy with aspirin and an oral

P2Y12 inhibitor is indicated for at least 12 months as the default strategy in patients with ACS who are not at high bleeding risk. Several strategies are available to reduce bleeding risk in patients with ACS who have undergone PCI and require antiplatelet therapy: (a) in patients at risk for gastrointestinal bleeding, a proton pump inhibitor is recommended; (b) in patients who have tolerated dual antiplatelet therapy with ticagrelor, transition to ticagrelor monotherapy is recommended ≥1 month after PCI; or (c) in patients who require long-term anticoagulation, aspirin discontinuation is recommended 1 to 4 weeks after PCI with continued use of a P2Y12 inhibitor (preferably clopidogrel). 3.	 High-intensity statin therapy is recommended for all patients with ACS, and with the option to initiate concurrent ezetimibe. A nonstatin lipid-lowering agent (eg, ezetimibe, evolocumab, alirocumab, inclisiran, bempedoic acid) is recommended for patients already on maximally tolerated statin who have a low-density lipoprotein cholesterol level of ≥70 mg/dL (1.8 mmol/L). It is reasonable in this high-risk population to further intensify lipidlowering therapy if the low-density lipoprotein cholesterol level is 55 to <70 mg/dL (1.4 to <1.8 mmol/L) and patient is already on a maximally tolerated statin. 4.	 In patients with non–ST-segment elevation ACS who are at intermediate or high risk of ischemic events, an invasive approach with the intent to proceed with revascularization is recommended during hospitalization to reduce major adverse cardiovascular events. In patients with non–ST-segment elevation ACS who are at low risk of ischemic events, a routine invasive or selective invasive approach with further risk stratification is recommended to help identify those who may require revascularization and to reduce major adverse cardiovascular events. 5.	 Two procedural strategies are recommended in

patients with ACS who are undergoing PCI: (a) radial approach is preferred over femoral approach in patients with ACS undergoing PCI to reduce bleeding, vascular complications, and death; and (b) intracoronary imaging is recommended to guide PCI in patients with ACS with complex coronary lesions.

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