The 2023 European Society of Cardiology (ESC) guidelines for acute coronary syndromes (ACS) introduced several practice-changing recommendations. A registry-based retrospective study presented at the Heart Failure 2026 evaluated how implementation of these recommendations influenced real-world clinical practice and in-hospital outcomes.
The single-center analysis included 1,455 patients hospitalized with ACS who were enrolled in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and July 2025. Patients were categorized as Group A (treated before guideline implementation; n= 1154) and Group B (treated after guideline implementation; n= 301).
Findings
- Patients treated after guideline implementation were younger (65.6 ± 12.9 vs 67.3 ± 12.7 years; p=0.043), more frequently smokers (30.2% vs 23.2%; p=0.012), and had higher rates of previous PCI (15.6% vs 10.8%; p=0.022).
- STEMI admissions increased after guideline adoption (56.8% vs 45.4%; p<0.001).
- Coronary angiography rates increased (99.7% vs 96.6%; p=0.004), along with PCI utilization (85.0% vs 76.8%; p=0.002) and staged PCI (28.9% vs 19.0%; p=0.002).
- Among patients with non-ST-segment elevation myocardial infarction (NSTEMI), time to coronary angiography decreased from 36.8 to 18.7 hours (p<0.001).
- In STEMI, fibrinolysis use declined (2.0% vs 11.6%; p<0.001), and pre-catheterization P2Y12 loading became less frequent (59.6% vs 85.1%; p<0.001).
- In-hospital heart failure decreased (14.0% vs 21.0%; p=0.006), as did cardiogenic shock (1.3% vs 4.9%; p=0.006) and mechanical complications (0% vs 1.0%; p=0.035).
- Mean hospital stay was shorter after guideline implementation (5 ± 3 vs 6 ± 4 days; p=0.003).
- Referral to cardiac rehabilitation increased significantly (52.7% vs 16.9%; p<0.001).
In this real-world registry analysis, implementation of the 2023 ESC ACS guidelines was associated with substantial changes in invasive and pharmacologic management, accompanied by lower rates of several in-hospital complications and shorter hospitalization duration.
