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Guideline registry — ischemic heart disease

Last verified: 2026-09-02. PubMed-indexed additions were resolved through live E-utilities; all 22 retained NCT identifiers in the condition were re-resolved through ClinicalTrials.gov API v2. Official-web entries were not re-fetched in this evidence-expansion pass; their last documented verification remains 2026-08-30.

Master table

Body Year Region Scope Citation Status
AHA/ACC/ACCP/ASPC/NLA/PCNA 2023 US Chronic coronary disease Virani et al., PMID 37471501 Current
ESC 2024 Europe/international Chronic coronary syndromes Vrints et al., PMID 39210710 Current
ACC/AHA/ACEP/NAEMSP/SCAI 2025 US Acute coronary syndromes Rao et al., PMID 40014670 Current
ESC 2023 Europe/international Acute coronary syndromes Byrne et al., PMID 37622654 Current
ESC 2020/2021 Europe/international NSTE-ACS Collet et al., PMID 32860058 Superseded by → ESC ACS 2023
ACC/AHA/SCAI 2021 US Coronary revascularization Lawton et al., PMID 34895950 Current; read with 2023 CCD/2025 ACS
ESC/EACTS 2018 Europe Myocardial revascularization Later left-main review: PMID 37632766 Partly superseded/reviewed
ESC/EACTS joint task force 2022/2023 Europe Left-main revascularization reassessment Byrne et al., PMID 37632756 Current focused reassessment
AHA/ACC et al. 2021 US Chest-pain diagnosis Gulati et al., PMID 34709879 Current
ESC 2021 Europe Cardiovascular prevention Visseren et al., PMID 34458905 Current
ESC/EAS 2019 Europe Dyslipidaemias Mach et al., PMID 31504418 Updated by → 2025 focused update
ESC/EAS 2025 Europe Dyslipidaemias focused update PMID 40885687 Current update
NICE 2020; reviewed 2026 UK ACS and post-MI prevention NG185 Current
NHFA/CSANZ 2025 Australia/NZ ACS Official guideline; summary PMID 41693087 Current
CCS/CAIC 2023/2024 Canada Antiplatelet therapy focused update CCS library Current
CCS/CWHHA 2024 Canada MINOCA clinical practice update CCS library Current
JCS 2023 Japan Primary prevention of CAD JCS release Current
WHO 2007 Global/LMIC adaptation Total CVD risk prevention WHO guideline Current framework; aging
WHO HEARTS 2020 Global/primary care Risk-based CVD management WHO HEARTS Current implementation package
South African NDoH 2024 South Africa Hospital-level cardiovascular treatment/essential medicines Adult hospital STG/EML Current national formulary guidance

Document notes

AHA/ACC chronic coronary disease 2023

  • Citation: Virani SS, et al. Circulation. 2023;148:e9–e119. PMID 37471501.
  • Contribution: integrates secondary prevention, antianginal treatment, revascularization, exercise/rehabilitation, and selected colchicine/dual-pathway use after COURAGE and ISCHEMIA.
  • Boundary: US regulatory and access context; diagnostic detail partly delegated to the 2021 chest-pain guideline.

ESC chronic coronary syndromes 2024

  • Citation: Vrints C, et al. Eur Heart J. 2024;45:3415–3537. PMID 39210710.
  • Contribution: likelihood-based diagnosis, CCTA/functional imaging, ANOCA/INOCA, antianginal and event-prevention pathways, explicit LDL goals.
  • Difference from US: more goal-based lipid language and a differently structured antianginal/diagnostic algorithm.

ACC/AHA ACS 2025

  • Citation: Rao SV, et al. Circulation. 2025;151:e771–e862. PMID 40014670.
  • Contribution: unified US ACS document after contemporary complete-revascularization, abbreviated-DAPT, imaging, and post-MI beta-blocker evidence.
  • Status: newest PubMed-indexed US ACS guideline in the live search.

ESC ACS 2023

  • Citation: Byrne RA, et al. Eur Heart J. 2023;44:3720–3826. PMID 37622654.
  • Contribution: unified STEMI and NSTE-ACS guidance, superseding separate syndrome documents.
  • Supersession: ESC 2020 NSTE-ACS (PMID 32860058) → ESC 2023 ACS.

ACC/AHA/SCAI revascularization 2021

  • Citation: Lawton JS, et al. J Am Coll Cardiol. 2022;79:e21–e129. PMID 34895950 (co-published in Circulation).
  • Contribution: Heart Team decisions, anatomy/diabetes/LV-function distinctions, CABG versus PCI, completeness and surgical-risk considerations.
  • Watch: STICH3C and long-term left-main data may change route-specific recommendations.

ESC/EACTS revascularization lineage

  • Current handling: the 2018 guideline was formally reassessed for left-main disease; the joint review is PubMed-indexed (PMID 37632766).
  • Dispute: endpoint definitions and interpretation of EXCEL/NOBLE changed the perceived equivalence of PCI and CABG.
  • Exact focused grades: for stable left-main disease with low/intermediate SYNTAX score, anatomy suitable for either route, and low predicted surgical mortality, CABG is Class I, Level A and PCI Class IIa, Level A; pooled randomized data were sufficient to exclude only large mortality differences (Byrne 2023, PMID 37632756).

Chest pain 2021

  • Citation: Gulati M, et al. Circulation. 2021;144:e368–e454. PMID 34709879.
  • Contribution: structured risk pathways and prominent CCTA; discourages “atypical” language that can bias evaluation.

ESC prevention and dyslipidaemia lineage

  • Prevention: Visseren et al., PMID 34458905.
  • Dyslipidaemias: Mach et al., PMID 31504418 → 2025 focused update, PMID 40885687.
  • Contribution: explicit very-high-risk LDL-C goals, combination therapy, lifetime-risk framing.

NICE NG185

  • Official source: NICE NG185, published 2020 and last reviewed 27 March 2026; accessed 2026-08-30.
  • Scope: STEMI, NSTEMI/unstable angina, complete revascularization, DAPT/anticoagulant combinations, post-MI drugs, CR and lifestyle.
  • Distinctive feature: recommendations integrate NHS cost-effectiveness and specify a GRACE-based angiography threshold in stable NSTE-ACS.

Australia/New Zealand ACS 2025

  • Official source: Heart Foundation guideline, accessed 2026-08-30; published summary Brieger et al., PMID 41693087 (live PubMed/web verification).
  • Contribution: acute coronary occlusion MI patterns beyond classic STEMI, hs-troponin pathways, imaging-guided PCI, underserved populations, mental health and equity.
  • Supersession: replaces the 2016 Australian ACS guideline.

Canada

  • Official source: CCS guideline library, verified from a live indexed result on the official CCS domain 2026-08-30 after direct retrieval timed out.
  • Current relevant entries: 2023 focused antiplatelet update and 2024 MINOCA clinical practice update.
  • Gap: no single recent Canadian document matching the breadth of US CCD or ESC CCS was identified in the official library search.

Japan

WHO and LMIC implementation

  • WHO total-risk guideline: official publication, 2007, accessed 2026-08-30.
  • WHO HEARTS: risk-based CVD management module, 2020, accessed 2026-08-30.
  • Contribution: low-resource primary-care risk assessment and essential-treatment delivery; not a substitute for ACS/revascularization guidance.

South Africa

Disagreements and gaps

  1. LDL goals versus thresholds. ESC specifies lower numeric goals plus ≥50% reduction; US CCD emphasizes maximally tolerated statin and add-on thresholds. Both support intensive lowering, but escalation timing differs (Mach 2020, PMID 31504418; Virani 2023, PMID 37471501; Vrints 2024, PMID 39210710).
  2. Colchicine after CLEAR SYNERGY. Guidelines incorporating COLCOT/LoDoCo2 preceded or only partly incorporate the neutral acute-MI result (Jolly 2025, PMID 39555823). Routine versus selected use needs reassessment.
  3. Left-main PCI. US/European recommendations depend on anatomy and surgical risk, but procedural-MI definitions and longer-term spontaneous MI/reintervention remain disputed (joint review PMID 37632766).
  4. INOCA evidence grade. ESC 2024 and consensus documents recognize function testing; symptom benefit is demonstrated, hard outcomes are not (CorMicA PMID 30266608).
  5. Post-MI beta-blockers with preserved EF. REDUCE-AMI was neutral and ABYSS did not prove interruption noninferior (Yndigegn 2024, PMID 38587241; Silvain 2024, PMID 39213187); duration recommendations remain conditional.
  6. Access-sensitive recommendations. PCSK9 therapy, CCTA, invasive function testing, and rapid PCI networks are not equally deliverable; WHO/South African documents optimize a different resource constraint from US/ESC guidance.
  7. Underrepresented groups. Advanced CKD, frailty, pregnancy, older multimorbid adults, and many ancestry groups have thinner direct evidence.
  8. DAPT duration versus its evidence lineage. Twelve-month ACS DAPT remains a Class I recommendation, but CURE compared DAPT with no DAPT and averaged about 9 months rather than randomizing 12 versus shorter duration; contemporary abbreviated and extended strategies apply to different bleeding/ischemic phenotypes (Valgimigli 2024, PMID 39038086).
  9. Class I rehabilitation versus implementation. Post-MI/revascularization CR is Class I, Level A, yet US participation was estimated at only 20%–30%; the Million Hearts 70% target was modeled to prevent 25,000 deaths and 180,000 hospitalizations annually, contingent on uptake (Ades 2017, PMID 27855953).
  10. Coverage does not erase delivery gradients. In Sweden, highest versus lowest income was associated with more than twice the odds of CR physical training and education after MI despite publicly financed care (Ohm 2021, PMID 33688966).

Evidence shocks that require recommendation maintenance

Newer evidence Earlier default it pressures Current reconciliation
REDUCE-AMI neutral in preserved EF (PMID 38587241) Indefinite routine beta-blocker after every MI Do not infer that interruption is safe: ABYSS failed to establish noninferiority (PMID 39213187); distinguish initiation from discontinuation.
CLEAR SYNERGY neutral after acute MI (PMID 39555823) Broad colchicine adoption based on COLCOT/LoDoCo2 Preserve the positive chronic/recent-MI trials but avoid a universal class statement; reassess timing, adherence, inflammation, and competing harm.
ORBITA-2 positive symptom result (PMID 38015442) after ORBITA's neutral exercise-time endpoint (PMID 29103656) Either “PCI never relieves stable angina” or “PCI always relieves angina” State medication context, endpoint, sham control, and phenotype; prognosis remains separate from symptom efficacy.
CULPRIT-SHOCK benefit of culprit-only initial PCI (PMID 29083953) Immediate complete PCI extrapolated from stable multivessel STEMI Separate shock from hemodynamically stable COMPLETE/MULTISTARS populations (PMID 31475795; PMID 37634190).
REVIVED neutral PCI and nonselective viability analysis (PMID 36027563; PMID 37878295) Pooling CABG and PCI as “revascularization” in ischemic LV dysfunction Preserve STICHES CABG evidence and require route-specific recommendations (PMID 27040723).
AUGUSTUS/AF-PCI program bleeding reductions (PMID 30883055; PMID 28844193; PMID 31492505) Prolonged triple therapy after PCI in AF Minimize aspirin duration when appropriate, but retain early ischemic-risk assessment and correct anticoagulant dosing.

Recommendation assumptions that should be visible

Recommendation area Hidden assumption What to record locally
CCTA-first diagnosis Scanner quality, expert interpretation, contrast access, downstream testing capacity Wait time, nondiagnostic rate, incidental findings, contrast injury, invasive angiography yield
Invasive ANOCA/INOCA testing Acetylcholine/adenosine protocols and endotype-linked therapy are available Test completeness, complications, endotype yield, symptom response, repeat-care use
PCSK9/inclisiran escalation Affordability, cold chain/injection delivery, longitudinal adherence Eligibility-to-initiation gap, achieved LDL-C, discontinuation, out-of-pocket cost
Short DAPT/P2Y12 monotherapy Contemporary stent, event-free run-in, reliable follow-up, population transportability ACS status, complexity, early events, bleeding definition, agent, adherence
Complete STEMI revascularization Hemodynamic stability and acceptable renal/contrast risk Shock, renal function, contrast volume, physiology use, immediate versus staged timing
Cardiac rehabilitation Referral converts to enrollment and adequate completed dose Offer, enrollment, completion, mode, equity strata, functional and clinical outcomes

This assumptions table prevents a nominally guideline-concordant recommendation from being treated as guideline-concordant implementation when the diagnostic, drug-delivery, follow-up, or emergency-network infrastructure is absent.

Watch list

Item Why it may change guidance Source to monitor
STICH3C (NCT05427370) Direct CABG-versus-PCI evidence in ischemic LV dysfunction ClinicalTrials.gov; major cardiology journals
ARTEMIS (NCT06118281) Outcome-scale IL-6 inhibition after MI ClinicalTrials.gov; ACC/ESC updates
Lp(a)HORIZON/OCEAN(a) First selective Lp(a) outcome evidence NCT04023552; NCT05581303
PREVENT follow-up Prophylactic PCI of vulnerable plaques NCT02316886
ESC CCS focused updates New colchicine, beta-blocker, Lp(a) and lesion-treatment evidence ESC guideline portal
ACC/AHA CCD update 2025 ACS evidence and emerging lipid/inflammation trials AHA/ACC guideline portal
NICE NG185 surveillance Last reviewed March 2026; pharmacogenetics decision documented NICE history page
Australia ACS implementation New 2025 guideline and equity recommendations Heart Foundation/CSANZ

Registry scope: documents with direct relevance to diagnosis, chronic/acute management, revascularization, lipids, antithrombotics, or implementation. Negative regional findings are dated search results, not permanent absences; the official regional sources represented above were rechecked on 2026-08-30.