2026 Southeastern Residency Conference

Background: In February 2025, the American College of Cardiology (ACC) and American Heart Association (AHA) released updated guidelines for acute coronary syndrome (ACS) management. Key medication-related updates include a preference for ticagrelor or prasugrel over clopidogrel in patients undergoing percutaneous coronary intervention (PCI), as well as more aggressive lipid management strategies recommending the addition of non-statin therapies in patients who do not achieve recommended low-density lipoprotein cholesterol (LDL-C) targets of < 55-70 mg/dL despite maximally tolerated statin therapy. This study aims to evaluate changes in prescribing patterns following guideline release at a tertiary medical center and to identify potential barriers to adoption.
Methods: This single-center, retrospective cohort study will evaluate adult patients diagnosed with Non–ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI) who underwent PCI between October 1, 2024 and January 31, 2025 (pre-guideline cohort), and June 1, 2025 and September 30, 2025 (post-guideline cohort). Patients requiring coronary artery bypass graft (CABG) surgery will be excluded. A three-month washout period following publication of the updated guidelines until June 1, 2025 was incorporated to allow for integration into clinical practice. Data will be abstracted from the electronic medical record (EMR) and will include patient demographics, ACS presentation, baseline laboratory values, and medication prescribing patterns, including discharge antiplatelet therapy and lipid-lowering therapy. All data will be de-identified prior to analysis. Descriptive statistics will be used to summarize baseline characteristics and prescribing patterns. Categorical variables will be compared between cohorts using chi-square analysis to evaluate differences in guideline adoption before and after publication. Statistical significance will be defined as a p-value <0.05.
Results: A total of 442 patients with STEMI or NSTEMI were screened, of whom 97 met inclusion criteria (pre-guideline cohort n=46; post-guideline cohort n=51). Baseline characteristics were generally similar between groups, although statin intolerance was more common in the post-guideline cohort (13.7% vs 2.2%, p=0.037) and oral anticoagulant use at discharge was lower (9.8% vs 26.1%, p=0.035). Appropriate P2Y12 inhibitor prescribing at discharge increased numerically following guideline publication (50% vs 56.9%), though this difference was not statistically significant (p=0.499); however, the distribution of discharge P2Y12 inhibitor selection differed significantly between cohorts (p=0.001), with increased use of prasugrel and ticagrelor and reduced use of clopidogrel post-guideline. Nonstatin lipid-lowering therapy prescribing increased from 15.2% to 23.5% (p=0.303), while appropriate statin prescribing remained high in both groups (91.3% vs 98%, p=0.129).
Conclusion: Following the 2025 ACS guideline update, prescribing patterns shifted modestly toward guideline-preferred P2Y12 inhibitors and increased use of nonstatin lipid-lowering therapies after PCI, though adoption remained incomplete and may have been influenced by factors such as baseline oral anticoagulant use and cost limitations. These findings highlight the need for continued education and targeted strategies to improve implementation of updated guideline-directed discharge therapy after PCI.