What Is New in the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes

For the first time, European Society of Cardiology (ESC) guidelines have aggregated in 1 single document recommendations for the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). From a clinical perspective, this is coherent, as the spectrum of clinical presentations in acute coronary syndromes (ACS) may range from new onset or progressive troponin-negative angina to STEMI, cardiogenic shock, or cardiac arrest. In addition, the management pathways of NSTE-ACS and STEMI patients are widely similar. Compared with previous editions of the guidelines, the extensive document is improved also from a graphic perspective, containing several appealing and easy-to-understand figures. New or modified recommendations include, among others, the topics of diagnostic work-up, timing of invasive strategy, revascularization in multi-vessel disease, intravascular imaging, cardiac arrest, cardiogenic shock, and antithrombotic treatment. For the first time in the field of ACS, ESC guidelines have incorporated a section on patient perspectives with dedicated recommendations. Some of the most relevant changes in recommendations impacting clinical practice are discussed in this article.