Korean Circ J.  2024 Dec;54(12):767-793. 10.4070/kcj.2024.0257.

2024 Korean Society of Myocardial Infarction/National Evidence-Based Healthcare Collaborating Agency Guideline for the Pharmacotherapy of Acute Coronary Syndromes

• Kim HK
• Ryoo S
• Lee SH
• Hwang D
• Choi KH
• Park J
• Lee HJ
• Yoon CH
• Lee JH
• Hahn JY
• Hong YJ
• Hwang JY
• Jeong MH
• Park DA
• Nam CW
• Kim W

• KMID: 2563793
• DOI: http://doi.org/10.4070/kcj.2024.0257

Abstract

Many countries have published clinical practice guidelines for appropriate clinical decisions, optimal treatment, and improved clinical outcomes in patients with acute coronary syndrome. Developing guidelines that are specifically tailored to the Korean environment is crucial, considering the treatment system, available medications and medical devices, racial differences, and level of language communication. In 2017, the Korean Society of Myocardial Infarction established a guideline development committee. However, at that time, it was not feasible to develop guidelines, owing to the lack of knowledge and experience in guideline development and the absence of methodology experts. In 2022, the National EvidenceBased Healthcare Collaborating Agency collaborated with a relevant academic association to develop internationally reliable guidelines, with strict adherence to the methodology for evidence-based guideline development. The first Korean acute coronary syndrome guideline starts from the 9 key questions for pharmacotherapy.

Keyword

Acute coronary syndrome; Pharmacotherapy; Clinical practice guideline

Figure

• 

  Figure 1 Lipid lowering therapy in patients with ACS.ACS = acute coronary syndrome; LDL-C = low-density lipoprotein cholesterol; PCSK9 = proprotein convertase subtilisin-kexin type 9.*The insurance coverage for PCSK9 inhibitor in Korea is applied for patients when LDL-C is higher than 70 mg/dL after using maximally tolerated statin plus ezetimibe.

• 

  Figure 2 Renin-angiotensin-aldosterone system inhibitors use in patients with ACS.ACEi = angiotensin-converting enzyme inhibitors; ACS = acute coronary syndrome; ARB = angiotensin receptor blockers; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonist.*The criteria related to LVEF were inconsistent in the use of MRA.

• 

  Figure 3 Beta blocker use in patients with ACS.ACS = acute coronary syndrome; LVEF = left ventricular ejection fraction.

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  Figure 4 Dual antiplatelet therapy strategies in patients with ACS.ACS = acute coronary syndrome; ARC-HBR = Academic Research Consortium for High Bleeding Risk; DAPT = dual antiplatelet therapy; PRECISE DAPT = Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy.*High ischemic risk patients refer to patients with age ≥65 years, diabetes mellitus, recurrence of myocardial infarction, multi-vessel disease, and chronic kidney disease, but there may be changed regarding to the clinical situation.†High bleeding risk is defined as PRECISE DAPT score ≥25 or meeting the ARC-HBR criteria.

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