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New acute coronary syndromes clinical guideline 2025
New Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025
The Heart Foundation and the Cardiac Society of Australia and New Zealand have released the new Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025. This launch represents a significant advance in the care of people experiencing a heart attack and angina in Australia.
Explore our interactive ACS guideline hub to access the guideline and to discover what's new for your clinical practice.
About the ACS guideline
Each year in Australia, there are over 57,000 acute coronary events among people aged 25 and over. This is equivalent to nearly 160 people every day, or one person every nine minutes.1
Behind these statistics are the real people and families whose lives have been changed by a heart attack. The Heart Foundation is committed to improving survival and quality of life outcomes for people experiencing these events.
The Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025 is critical to improving outcomes for people experiencing a heart attack or angina in Australia. The guideline has been endorsed by 15 peak body organisations to date, recognising the value of the new guideline to healthcare professionals working across the care continuum and in a diverse range of settings.
The guideline replaces the National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016 with updated evidence-based recommendations and practice advice.
Who can use this guideline?
This guideline is intended for use by all healthcare professionals involved in the care of people with ACS.
It is also intended to provide the best available evidence to support researchers and academics with an interest in cardiovascular health in advancing research, as well as health system policy makers in developing population health policy.
What’s new in the guideline?
New terminology and definitions
This guideline adopts the new term acute coronary occlusion myocardial infarction (ACOMI).
ACOMI includes atherosclerotic and non-atherosclerotic causes, referred to in the previous guideline as ‘type 1 myocardial infarction’ and ‘type 2 myocardial infarction’ respectively.
This change in terminology is to emphasise clinical conditions which are considered equivalents to ST-segment elevation myocardial infarction (STEMI), such as spontaneous coronary artery dissection (SCAD), coronary embolism and coronary vasospasm or microvascular dysfunction. These equivalents are often under recognised in emergency settings, as they are similar in terms of clinical presentation and investigation findings.
Visit section: Abbreviations and Terminology
Assessment and diagnosis
New guidance on the assessment and diagnosis of people with suspected or confirmed acute coronary syndromes (ACS):
- Description of multiple ECG patterns of ACOMI, beyond the traditional ST-segment elevation criteria, which should prompt consideration of emergency reperfusion.
- New clinical decision pathways incorporating high-sensitivity cardiac troponin assays to enable more efficient risk assessment compared with traditional (contemporary/conventional) troponin-based algorithms.
- For people classed as intermediate risk, invasive cardiac testing is now an option to further stratify and assess risk beyond 30 days.
Visit section: 1. Assessment and diagnosis
Hospital care and reperfusion
New guidance on the acute management of people with STEMI or non-ST-segment elevation acute coronary syndromes:
- Stronger emphasis on the optimal timing of primary percutaneous coronary intervention (PCI) in people with STEMI:
- <60 minutes from first medical contact at PCI-capable centres
- <90 minutes from first medical contact at non-PCI capable centres/emergency services.
- New evidence for use of intravascular imaging-guided PCI in people with non-ST-segment elevation acute coronary syndromes.
- New recommendations for managing ACS with cardiac arrest and/or cardiogenic shock, including considerations for use of haemodynamic support devices and left ventricular assist devices.
- New recommendations on the treatment of multivessel disease, including specific timing of PCI of non-infarct related arteries and considerations for invasive physiology assessment.
- New recommendations for the management of ACS due to SCAD, including considerations for selective revascularisation.
Visit section: 2. Hospital care and reperfusion
Recovery and secondary prevention
New recommendations and guidance on non-pharmacological and pharmacological secondary prevention measures:
- More detailed advice on post-discharge care, including medicines and adherence strategies, vaccinations and screening for mental health conditions.
- Treatment algorithms to enable more tailored prescribing of antiplatelet and anticoagulation therapies.
- A new recommended treatment target for low density lipoprotein cholesterol (LDL-C) of <1.4 mmol/L and a reduction of at least 50% from baseline.
- New recommendations on select medicines including beta blockers and PCSK9 inhibitors.
Visit section 3. Recovery and secondary prevention
Considerations for priority populations
New practice points address the unique needs of priority populations with suspected or confirmed ACS, including women, older adults, First Nations peoples and people living in regional and remote areas.
Who has endorsed the guideline?
- Advanced Pharmacy Australia (AdPha)
- Australasian Cardiovascular Nursing College (ACNC)
- Australasian College for Emergency Medicine (ACEM)
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS)
- Australian Cardiovascular Health and Rehabilitation Association (ACRA)
- Australian Physiotherapy Association (APA)
- Central Australian Rural Practitioners Association (CARPA)
- Council of Remote Area Nurses of Australia (CRANA)
- Exercise & Sports Science Australia (ESSA)
- Internal Medicine Society of Australia and New Zealand (IMSANZ)
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP)
- The Australasian College of Paramedicine (ACP)
- The Australian Resuscitation Council (ARC)
- The National Rural Health Alliance (NRHA)
- The Royal College of Pathologists of Australasia (RCPA)
How was the guideline developed?
The guideline was developed in consultation with a broad range of clinical experts and people with lived experience, ensuring representation across different geographic regions, sex, genders, ethnicities, clinical settings and perspectives. In addition, organisations, including those with people with lived experience interests and professional expertise, were also involved.
People with lived experience provided critical insight during every stage of guideline development to ensure it addresses the unique needs and preferences of people experiencing a heart attack or angina.
Based on the Grading of recommendations, assessment, development, and evaluation (GRADE) methodology, the expert groups developed and graded the recommendations. In some instances, recommendations were adopted or adapted from existing international guidelines.
Practice points were developed with consideration of the geographical challenges in Australia and availability of resources in Australian healthcare settings. Where there were specific practice points, evidence and/or resources relevant to underserved populations (women, older adults, First Nations peoples, and people living in regional and remote areas), this was included in the guideline.
Further details of the guideline development process can be found in the About the guideline section.
References
- Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts. 2024. aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/all-heart-stroke-and-vascular-disease/coronary-heart-disease
Last updated02 April 2025
Last reviewed02 April 2025