JACC This Week

Kausik Ray, a Professor of Public Health and Cardiologist at Imperial College London, discusses the 2025 ACC/AHA Acute Coronary Syndrome guidelines. He emphasizes the revolutionary shift from solely using statins to embracing combination therapies for lipid management. The conversation highlights the necessity of initiating these combinations—statins, ezetimibe, and PCSK9 inhibitors—simultaneously for high-risk patients. This approach aims to bridge the gap between clinical practice and evidence-based strategies, ultimately improving patient outcomes.

JACC's June 10 issue focuses on the 2025 ACS guidelines, and this unique piece features JACC Deputy Editor James L. Januzzi Jr., Eugene Braunwald, MD, MACC, and Elliott M. Antman, MD, providing their thoughts on the historical evolution of ACS diagnosis and treatment. The discussion underscores a call to action for implementation of these comprehensive, evidence-based recommendations to improve patient outcomes. Read the article online and listen to this interview with these pioneers in the field of cardiology for additional perspectives.

JACC Deputy Editor Lesley Curtis, PhD, speaks with authors Celina Yong, MD, FACC, and Robert M. Califf, MD, on this unique perspective piece published in JACC's June 2 issue. Drs. Califf and Yong discuss their viewpoint article on 25 years of ACS (acute coronary syndrome) guidelines, highlighting both progress and persistent evidence gaps. While they note improvements in the proportion of recommendations based on high-quality evidence, they emphasize the fragility of this progress, the lack of applicability to diverse patient populations, and the need for broader, more inclusive research efforts to address everyday clinical questions. Integration of evidence with a focus on professionalism, quality, and communication continues to be necessary to avoid relegating medicine to provision of services for fees with an emphasis on the most profitable services, but instead a professional calling to learn continuously and improve the well-being of all patients.

Sunil V. Rao, MD, FACC, provides his perspective as the Writing Committee Chair of the 2025 Acute Coronary Syndrome (ACS) guidelines. Dr. Rao discusses the challenges of defining the scope, managing rapidly evolving evidence, and coordinating a large writing committee to deliver a timely and evidence-based update—the first in over a decade. Tune in for this behind-the-scenes look at the collaborative nature of the process and the importance of continued updates as new data emerge.

JACC's June 10 issue, focusing on the ACS guideline, features a series of videos with unique perspectives. In this video, JACC: Executive Associate Editor Karthik Murugiah, MBBS, MHS, FACC, introduces his paper discussing the guideline's reliance on four landmark RCTs in AMI-CS. Several sweeping changes in recommendations for MCS use have been codified that should influence practice and improve care for these high-risk patients. While IABP use is expected to decrease, use of mAFP is likely to increase but should be judicious, with caution against overgeneralizing given the narrow selection criteria of DanGer Shock. Evaluating real-world practice patterns and outcomes of patients with AMI-CS based on these recommendations will be paramount.

In this episode, hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, are joined by Dr. Yoichiro Sugizaki, MD, for an in-depth discussion on his landmark OCT-based study investigating chronic stent recoil (CSR) and its impact on target lesion revascularization (TLR) in the contemporary era of thin-strut, second-generation drug-eluting stents (DES). Together, they delve into the frequency, mechanisms, and clinical relevance of CSR—an underappreciated phenomenon increasingly observed in heavily calcified or eccentric lesions despite technological advancements in stent design. The conversation underscores why recognizing CSR is essential for interventional cardiologists and explores practical strategies to mitigate its impact.

In this special edition of JACC, Dr. Valentin Fuster offers an in-depth summary of the 2025 ACC/AHA guidelines on acute coronary syndromes, highlighting expert perspectives and landmark updates. The episode explores key topics including high-sensitivity troponins, antithrombotic strategies, and a global push toward harmonized cardiovascular care guidelines. With historical context and forward-looking commentary, it's an essential listen for clinicians navigating the evolving landscape of acute cardiac care.

Hosts Mitsuaki Sawano, MD, and co-hosts Kentaro Ejiri, MD, and Satoshi Shoji, MD, are joined by HFpEF expert Hidenori Yaku, MD, from Northwestern University, for a deep dive into early treatment response to acoramidis, an amyloid stabilizer recently approved in Japan. They discuss its impact on serum transthyretin (sTTR) levels and the emerging role of sTTR as a dynamic biomarker of treatment efficacy. The episode explores the clinical relevance of early sTTR elevation, key insights from the ATTRibute-CM trial—including mediation and logistic regression analyses—and the use of waterfall plots to visualize treatment response. The team also compares acoramidis with tafamidis and vutrisiran, and looks ahead to the evolving therapeutic landscape of ATTR-CM, including gene editing and amyloid removal strategies.

In this special JACC lipid-focused issue, Dr. Valentin Fuster explores groundbreaking global research on lipoprotein(a), its complex role in cardiovascular disease across populations, and the promising future of targeted therapies. From massive Chinese cohort studies to a novel oral PCSK9 inhibitor trial, this episode highlights the frontlines of lipid science shaping tomorrow's heart health.

JACC focuses in again on Lipids in our June 3 issue, bringing critical insights into emerging targeted therapies. In the June 3 Deep Dive, editor-in-chief Harlan M. Krumholz, MD, SM, FACC, reviews the INTERASPIRE study by Ray et al, reviewing implications, key findings, and a thoughtful summary and analysis of the reviewer findings.